Search Results (343)

Background: Bone tissue is a dynamic structure capable of continuous remodeling; however, its regenerative capacity is limited in critical-size defects, often requiring the use of bone grafting procedures. Available grafting materials present inherent limitations, highlighting the need for strategies that can enhance regenerative outcomes. Hyaluronic acid (HA) has been proposed as a promising adjunctive agent because of its biological properties, including anti-inflammatory and pro-angiogenic effects. Objective: To systematically evaluate the available clinical evidence regarding the effects of HA as an adjunct in bone regeneration procedures, including alveolar ridge preservation, ridge augmentation, and maxillary sinus elevation. Materials and Methods: A systematic search was conducted in the PubMed, ScienceDirect, Google Scholar, and Wiley Online Library databases for studies published within the last 10 years. Clinical studies involving adult patients were included if they evaluated the local application of HA, regardless of formulation, and reported quantitative clinical, radiographic, histological, or histomorphometric outcomes related to bone regeneration. Results: Of the 728 records initially identified, 10 studies met the eligibility criteria and were included in the qualitative synthesis. Discussion: Overall, the available evidence suggests that HA may positively influence bone regeneration outcomes. The most consistent benefits were observed in alveolar ridge preservation and ridge augmentation procedures, including increased new bone formation, improved bone density, enhanced bone maturation, and reduced dimensional bone loss. In contrast, findings regarding maxillary sinus augmentation were less consistent. Conclusions: HA appears to be a promising adjunct in bone regeneration procedures. However, the current evidence remains limited and is primarily based on clinical outcomes, providing insufficient mechanistic data to fully elucidate its biological effects. Further well-designed randomized controlled trials with standardized protocols are required before definitive clinical recommendations can be established. Full article

Background/Objectives: Alveolar ridge atrophy following tooth extraction complicates subsequent prosthetic rehabilitation and implant placement. This systematic review seeks to provide a comprehensive evaluation of existing evidence regarding the effectiveness of xenogeneic bone graft materials in socket preservation, particularly emphasizing their influence on the adjacent soft tissues. Methods: A systematic literature search was carried out across the CENTRAL, Embase, MEDLINE, PubMed, and Scopus databases. The search targeted randomized controlled trials (RCTs) published in English between January 2015 and September 2025 that examined xenogenic bone grafts used for ridge preservation in comparison either to spontaneous socket healing or to other types of grafting materials. The primary outcomes of interest were bone regeneration and alterations in soft tissues. Multiple independent reviewers performed study screening, data extraction, and risk of bias evaluation using the RoB 2 tool. Results: From 2242 initial records, 4 RCTs (138 patients) met the inclusion criteria. Studies compared xenografts (deproteinized bovine bone mineral with/without collagen), often combined with membranes, to unassisted healing. Augmentation techniques consistently showed a trend toward reduced horizontal and vertical ridge contraction compared to controls, though differences often lacked statistical significance (p > 0.05). Histological analysis revealed significantly less vital bone formation and residual graft particles in xenograft sites versus controls, suggesting volume maintenance is largely graft-dependent. Soft tissue contour changes were evaluated using 3D model scanning. Risk of bias varied, with concerns regarding randomization and reported outcomes in some studies. Conclusions: Xenogenic materials demonstrate comparable clinical effectiveness in preserving alveolar ridge dimensions, though radiographic volume stability may be partially attributed to the slow resorption of the graft material itself rather than new bone formation. Full article

Periodontitis is a chronic inflammatory disease driven largely by dysregulated host responses that lead to destruction of periodontal tissues. Integrins are heterodimeric transmembrane receptors that regulate cell adhesion and bidirectional signaling in epithelial cells, immune cells, periodontal ligament fibroblasts, and osteoclasts. During disease progression, integrin-related responses may shift across overlapping molecular phases. Epithelial integrins such as α3β1 and α6β4 support barrier integrity, whereas α5β1 may facilitate microbial interaction and inflammatory signaling. β2 integrins and α4β1 contribute to leukocyte recruitment and inflammatory amplification, whereas increased α9β1-associated signaling and reduced αvβ6-mediated regulation of transforming growth factor β (TGF-β) may promote inflammatory persistence. Matrix-associated integrins, including α2β1 and α11β1, support extracellular matrix (ECM) organization and mechanotransduction, whereas αvβ3 cooperates with Receptor activator of nuclear factor kappa B ligand (RANKL) to promote osteoclast activity and alveolar bone resorption. Impaired β1 integrin-dependent signaling and potentially reduced αvβ5-associated efferocytosis may contribute to defective resolution and regeneration. Importantly, integrin expression, activation, and downstream signaling are distinct, and the strength of evidence varies among integrin subtypes. This review proposes a conceptual framework in which periodontitis reflects a dynamic imbalance in integrin-mediated processes that link inflammation, bone resorption, and regenerative failure, rather than being a direct equivalent of clinical periodontal stages or grades. Full article

Methods of ridge preservation following tooth extraction, aiming to maintain alveolar bone volume and support tissue regeneration, have been extensively researched. Continuously, new approaches and materials are being explored in this context. To scientifically evaluate outcomes, the pre-implant situation is usually assessed radiologically, histologically, and/or clinically. However, the influence of ridge preservation on implant placement itself is rarely examined in depth, and if at all, the focus has been on implant stability or survival rates. Based on the assumption that preoperative radiological assessment, including cone beam computed tomography, provides only an indirect and inherently limited approximation of actual intraoperative bone condition, undetected factors such as insufficient bone density, mechanically unfavorable trabecular structure, or incompletely resorbed residual biomaterial may necessitate a shift of the implant from the preferred position originally occupied by the tooth root. We therefore established a method that evaluates and categorizes implant position in three dimensions based on radiological data post-implantation. Our data, derived from a multicenter randomized clinical trial (RCT), demonstrate that the greatest positional deviations are observed without preservation, whereas the combination of biomaterial and PRF most frequently allowed for central implant placement. The proposed method proves well suited for evaluating the outcome of ridge preservation procedures. The findings demonstrate that both the absence and presence, and further the type, of preservation have a measurable influence on the final implant positioning. Full article

Periodontal disease remains one of the leading causes of tooth loss worldwide, highlighting the need for effective regeneration of alveolar bone, periodontal ligament, and cementum. The structural complexity and unique biological behavior of these tissues have historically posed significant challenges for clinical regeneration strategies. The primary therapeutic approach used is guided bone regeneration; however, it has certain limitations, such as morbidity, low structural integrity and dimensional stability. Recent advances in 3-dimensional (3D) bioprinting have made it possible to fabricate customized scaffolds with precise architecture and spatial organization that closely mimic normal periodontal structures. The incorporation of multifunctional nanocomposite biomaterials and nanoparticles further enhances the performance of the scaffolds by increasing mechanical strength, bioactivity and controlling degradation rates. These advanced scaffolds function as dynamic microenvironments that support cell adhesion, proliferation and differentiation, ultimately promoting tissue regeneration. Furthermore, their multifunctional properties allow for the controlled release of growth factors, anti-inflammatory and antimicrobial agents, as well as the incorporation of stem cells and bioactive molecules that facilitate angiogenesis. This review investigates and critically evaluates modern approaches for the regeneration of periodontal tissues through scaffolds, biomaterials and 3D bioprinting technologies, as well as to assess their effectiveness compared to established clinical practices. Full article

Magnesium-based membranes are promising biomaterials for guided bone regeneration due to their unique properties of mechanical strength, biocompatibility, and controlled biodegradation. This scoping review aimed to map and synthesize the available evidence regarding the use of magnesium-based membranes and fixation screws in alveolar ridge regeneration and guided bone regeneration procedures. Relevant studies were identified through a literature search conducted from November 2025 to May 2026, using several databases following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. Thirty-nine studies met the inclusion criteria, including in vitro studies, preclinical animal studies, clinical case reports and case series, and narrative or systematic reviews. In vitro studies demonstrated cytocompatibility and fibroblast adhesion, while moderate magnesium ion concentrations increased markers of osteogenic differentiation. Preclinical animal studies reported controlled degradation, biocompatible tissue responses, maintenance of barrier function during early healing, and findings suggesting potential osteogenic stimulation. Clinical evidence, limited to case reports and small case series, described the use of magnesium membranes in horizontal and vertical ridge augmentation, sinus lift procedures, immediate dentoalveolar regeneration, periodontal defects, and cystic lesions, with generally uneventful healing outcomes and preserved bone volume. Reported complications were mainly minor and included transient soft tissue reactions, membrane exposure, and localized gas cavity formation. However, the available evidence remains limited to low-level studies without controlled clinical trials. Current findings are insufficient to establish clinical efficacy or superiority over conventional membranes, highlighting the need for larger prospective controlled studies. The review’s findings could help researchers advance the understanding of bone regeneration and help develop new strategies to improve and further investigate bone regeneration. Full article

Background/Objectives: This retrospective study evaluated the dimensional behavior of an alveolar ridge preservation approach based on the placement of a subperiosteal heterologous cortical collagenic bone lamina without the use of particulate grafting material under routine clinical conditions. Methods: Seventy consecutive patients, each contributing one extraction site, were included. All sites were treated with a cortical lamina placed on the buccal aspect of the socket immediately after tooth extraction. Cone-beam computed tomography scans were obtained before extraction and after approximately 6 months of healing. Crestal width and vertical dimensions at the buccal, central, and lingual aspects were measured. An exploratory subgroup analysis was also performed according to the tooth region. Results: Over a mean follow-up period of 6.1 ± 1.4 months, the mean crestal width decreased from 8.4 ± 2.8 mm to 7.9 ± 1.8 mm, corresponding to a mean reduction of −0.6 ± 2.0 mm (p = 0.001). The central vertical measurement showed no significant change (0.4 ± 2.6 mm; p = 0.531). Buccal height remained stable, whereas lingual height showed a small reduction (−0.6 ± 1.7 mm; p = 0.005). The exploratory subgroup analysis revealed a width change of −0.3 ± 1.6 mm for anterior sites and 0.1 ± 2.0 mm for premolar sites while a more pronounced reduction in ridge dimensions was observed at molar sites (−2.2 ± 1.6 mm). Conclusions: The cortical lamina approach was associated with limited post-extraction dimensional changes and may represent a useful option for alveolar ridge preservation without the use of particulate grafting material, although less favorable dimensional stability may be expected in molar regions. Full article

Background: Periodontitis is characterized by loss of the periodontal ligament, cementum, and alveolar bone. Scaffold-based biomaterials are intended to provide a three-dimensional framework for periodontal wound stabilization and tissue regeneration, but their incremental clinical benefit over conventional regenerative therapy remains uncertain. This systematic review and meta-analysis evaluated scaffold-based periodontal regenerative procedures for probing depth (PD) reduction, clinical attachment level (CAL) gain, and radiographic defect fill compared with conventional treatment. Methods: Original randomized controlled trials published from January 2020 to 1 March 2026 were searched in MEDLINE (Ovid), Embase, CENTRAL, and Web of Science, screened in Rayyan, and meta-analyzed in RevMan v5.4. Certainty was evaluated using GRADE. Results: Thirty-one studies were included. Scaffold-based interventions produced statistically significant but clinically modest PD reductions at 6 months (MD = −0.27 mm; 95% CI: −0.43 to −0.10; p = 0.001; I² = 34%) and 12 months (MD = −0.21 mm; 95% CI: −0.41 to −0.01; p = 0.04; I² = 22%), but not at 24 months. The overall PD effect was small (MD = −0.26 mm; p < 0.0001). CAL gain was not significant at 6 or 12 months but was significant at 24 months (MD = 1.00 mm; p < 0.0001; I² = 0%). Defect fill improved at 12 months (MD = 0.51 mm; p = 0.02) but not at 6 months. Subgroup and meta-regression analyses did not identify significant effects of scaffold type or PRF/PRP enrichment (p > 0.05). Conclusions: Scaffold-based biomaterials may provide limited, time-dependent clinical and radiographic benefits as adjuncts to conventional periodontal regenerative therapy. The evidence remains constrained by heterogeneous interventions, modest effect sizes, low-to-very-low certainty for several outcomes, and a paucity of histologic confirmation of true periodontal regeneration. Full article

Periodontal ligament mesenchymal stem cells (PL-MSCs) are vital for both periodontal regeneration and alveolar bone maintenance, including their turnover during orthodontic therapy. Chronic periodontal inflammation, mainly caused by Gram-negative bacterial lipopolysaccharides (LPS), interferes with osteogenic differentiation and leads to bone loss. Increasing evidence indicates that long non-coding RNAs (lncRNAs) link inflammatory signaling to osteogenic regulation, but their specific role in LPS-driven modulation of PL-MSC osteogenesis is not well understood. The aim of this study was to assess the effects of LPS from two bacterial strains on PL-MSCs differentiation. Human PL-MSCs were cultured under standard stem cell or osteogenic conditions and treated with LPS from Escherichia coli or Porphyromonas gingivalis. Mineralization was assessed using Alizarin Red staining. Osteogenic differentiation was evaluated through immunocytochemical analysis of osteopontin, collagen type 1, osteocalcin, osteonectin, and dentin matrix protein-1 (DMP-1). Expression levels of lncRNAs growth arrest-specific transcript 5 (GAS5), Metastasis-Associated Lung Adenocarcinoma Transcript 1 (MALAT1), maternally expressed gene 3 (MEG3) and Nuclear Enriched Abundant Transcript 1 (NEAT1) were measured by real-time PCR at 6, 24 and 48 h of LPS exposure. Exposure to E. coli LPS significantly inhibited extracellular matrix mineralization and decreased the expression of key osteogenic markers, indicating impaired osteoblast maturation. In contrast, P. gingivalis LPS caused a partial, dysregulated osteogenic response, marked by increased expression of osteopontin, osteonectin, and dentin matrix protein-1 (DMP-1), but without complete differentiation. LPS types altered lncRNA expression profiles, suggesting that non-coding regulatory networks are involved in inflammation-induced osteogenic dysregulation. Multivariate analyses showed decreased expression of GAS5, MEG3, and MALAT1 in the LPS vs. CTR comparison, decreased COL1A1 in LPS-PG vs. CTR, and increased OSTEOPONTIN in LPS vs. CTR. Differentiation was significantly associated with reduced expression of XIST and NEAT1. Time exerted significant effects on GAS5, MEG3, XIST, and MALAT1, with lower expression at 48 h compared with 6 h, and on COL1A1, which was significantly reduced at both 24 h and 48 h relative to 6 h. Bacterial LPS disrupt osteogenic differentiation of PL-MSCs depending on the species, affecting matrix formation, mineralization, and lncRNA expression. These findings highlight lncRNA-mediated communication between inflammatory signals and osteogenic pathways, providing new insights into the molecular mechanisms of inflammation-related bone remodeling in periodontal disease and orthodontic movements. Targeting lncRNA-regulated pathways could be a promising strategy to enhance periodontal regeneration during inflammation and also ensure optimum outcomes in orthodontic therapy. Full article

Cytokines are key regulators of immune responses and tissue remodeling, playing a central role in physiological homeostasis and pathological inflammation. Dysregulation of cytokine signaling networks has been implicated in a wide range of diseases, where persistent inflammatory activation leads to progressive tissue destruction and impaired repair mechanisms. In the oral environment, cytokines critically influence the balance between tissue resorption and regeneration, particularly in processes involving dentin and alveolar bone remodeling. Pathological root resorption (PRR) represents a clinically significant model of cytokine-driven tissue destruction, characterized by the loss of dental hard tissues mediated by osteoclast-like cells within a dysregulated inflammatory microenvironment. Although mechanical, infectious, and iatrogenic factors are well-established triggers, they alone do not fully explain the variability in clinical outcomes, suggesting an important role for host-related factors. New research highlights the relationship between inflammatory signaling pathways, genetic susceptibility, and molecular biomarkers in shaping the onset and progression of PRR. In particular, the RANK/RANKL/OPG axis, cytokine networks, and gene polymorphisms have been identified as key determinants of osteoclast activation and resorptive activity. At the same time, advances in salivary and gingival crevicular fluid biomarker research provide new opportunities for early detection and real-time monitoring. Despite these advances, current knowledge remains fragmented, with heterogeneous study designs, inconsistent genetic associations, and a lack of standardized diagnostic protocols, all of which limit clinical translation. Therefore, a comprehensive and integrative synthesis of cytokine-mediated mechanisms in PRR is needed. This review aims to provide an updated and critical overview of cytokine and chemokine involvement in PRR, integrating molecular pathways, genetic determinants, and emerging biomarkers within a unified framework while highlighting translational implications for precision dentistry. Full article

Periodontitis-induced destruction of periodontal tissues and tooth loss remain major clinical challenges. Although periodontal regenerative therapies aim to reconstruct damaged structures, particularly the repair of alveolar bone defects, current biomaterials have limited capacity to simultaneously promote cell adhesion and osteogenic differentiation. Amelogenin (Am) plays a key role in mineralized tissue development through its highly conserved N-terminal and C-terminal regions, but studies have shown that Am has certain limitations in promoting cell adhesion. In contrast, the arginine-glycine-aspartic acid (RGD) domain of fibronectin (FN) effectively mediates cell–matrix adhesion. Based on these properties, we developed a novel recombinant fusion protein (rtAmR) by combining the conserved regions of Am with the RGD domain of FN. In vitro, rtAmR significantly promoted the adhesion and spreading of human stem cells from the apical papilla (hSCAPs) compared with the control group. Quantitative analysis showed that the number of adherent cells and the cell spreading area in the rtAmR group were 1.9-fold and 2.1-fold higher than those in the rhAm group, respectively. In osteogenic differentiation assays, rtAmR exhibited activity comparable to that of rhAm and even outperformed rhAm in terms of alkaline phosphatase (ALP) activity, collagen type I (COL I) expression, and calcium nodule formation. In a Sprague–Dawley (SD) rat alveolar bone defect model, rtAmR treatment significantly promoted bone regeneration, achieving superior bone volume/total volume (BV/TV) values compared to the rhAm and rhFN groups. Immunohistochemistry revealed that rtAmR did not obviously increase neutrophils, mast cells, or M2 macrophages versus control, confirming its biosafety and suggesting M2-independent osteogenesis. These findings suggest that rtAmR is a promising bifunctional bioactive protein for periodontal bone regeneration. Full article

Background/Objectives: Horizontal alveolar ridge resorption following tooth loss often compromises implant placement and requires augmentation procedures to restore adequate bone volume. This pilot case series descriptively evaluated the clinical, radiographic, and histological outcomes of lateral ridge augmentation (LRA) using a collagenated porcine-derived xenograft combined with autogenous bone. Methods: Three consecutive partially edentulous patients presenting with severe horizontal ridge deficiency (residual bone width ≤ 4 mm) underwent LRA using a mixture of porcine-derived xenograft and autogenous bone covered with a resorbable collagen membrane. After a healing period of 3–5 months, core biopsies were harvested at implant placement and subjected to histological and histomorphometric analysis, including TRAP staining. Results: All sites healed uneventfully without intraoperative or postoperative complications. Radiographic evaluation demonstrated substantial horizontal bone gain, allowing placement of standard-diameter implants. Histological analysis revealed newly formed trabecular bone, residual graft material, and well-vascularized connective tissue, indicating active bone regeneration and biomaterial integration. TRAP-positive multinucleated giant cells (MNGCs) were observed at the biomaterial interface, suggesting ongoing remodeling. Long-term follow-up (mean 54.2 months) showed stable implant function without biological or mechanical complications. Conclusions: Within the limitations of this pilot case series, LRA using a collagenated porcine-derived xenograft combined with autogenous bone demonstrated preliminary favorable clinical, radiographic, and histological outcomes. Full article

Background: The integrity of the alveolar ridge is compromised by tooth loss or trauma, initiating chronic resorption that alters bone morphology. Vertical bone augmentation (VBA) is a complex procedure required to rehabilitate severe atrophy. Currently, there is debate regarding the effectiveness of autologous bone versus xenografts and their combination to optimize bone regeneration and ensure dimensional stability. Objectives: To synthesize evidence on the efficacy of VBA by comparing autologous bone, xenografts, and their combination. Specifically, to evaluate vertical bone gain, volumetric stability and resorption, implant survival, complications, and whether combined grafts offer clinical advantages. Methods: A systematic review was conducted following PRISMA 2020 guidelines. MEDLINE, Scopus, SciELO, and Web of Science were searched up to January 2026. Risk of bias was assessed, using RoB 2 for randomized studies and ROBINS-I for non-randomized studies. Results: From 1517 initial records, 9 studies were included and 3 showed high risk of bias. Iliac crest grafts achieved the greatest vertical bone gain but also exhibited higher resorption compared to calvarial grafts. Xenografts (Bio-Oss) demonstrated superior volumetric stability, maintaining 10–13% more residual volume than autologous blocks. The most frequent complication was soft tissue dehiscence. Conclusions: VBA is an effective procedure. The combination of autologous bone and xenograft may represent a balanced approach, providing both biological potential and volumetric stability. Graft origin significantly influences outcomes and morbidity. However, current evidence is limited by methodological heterogeneity and small sample sizes, highlighting the need for well-designed clinical trials with standardized protocols and long-term follow-up. Full article

Background: Platelet concentrates (PCs), including platelet-rich fibrin (PRF) and its derivatives, have been increasingly investigated as autologous adjuncts in alveolar and periodontal regenerative procedures. This systematic review aimed to evaluate whether PCs improve clinical, radiographic, and histological outcomes compared with conventional regenerative approaches. Methods: A comprehensive search of PubMed, Scopus, and Web of Science identified randomized clinical trials on intrabony and furcation defects, alveolar ridge preservation, alveolar cleft reconstruction, and periodontally accelerated osteogenic orthodontics (PAOO). Sixteen studies met the inclusion criteria. Results: Overall, PCs, used alone as membranes or in combination with allograft materials, have been associated with significant clinical and radiographic improvements, with three main patterns of effect emerging across studies: (i) adjunctive benefit in selected outcomes (e.g., ridge width preservation and new bone formation when PRF was combined with graft materials); (ii) non-inferiority or equivalence compared with conventional regenerative approaches, particularly in periodontal intrabony defects; and (iii) lack of consistent superiority, as several studies reported comparable outcomes to standard techniques rather than clear advantages. In cleft reconstruction, PRF used in combination with allografts has shown comparable or non-inferior results to standard graft approaches, potentially reducing morbidity. Despite these favorable trends, evidence has been mixed in terms of platelet preparation protocols, defect types, additional biomaterials, and length of follow-up. The heterogeneity of the included studies and the absence of quantitative synthesis limit the strength of the conclusions. Conclusions: Within these limitations, PCs appear to represent a valid complement or alternative to conventional regenerative strategies, primarily as an adjunct rather than a clearly superior approach, and further well-designed randomized clinical trials with standardized protocols and longer follow-up are needed to strengthen clinical recommendations. Full article

This prospective, single-arm post-market study aimed to evaluate the clinical safety and performance of a synthetic calcium phosphate ceramic used in alveolar bone regeneration procedures. Eighty adult patients requiring bone augmentation were treated with β-tricalcium phosphate (β-TCP) under routine clinical indications. Surgical approaches were adapted to defect morphology. Safety outcomes included adverse events (AEs) and device deficiencies (DDs), while performance outcomes focused on two-dimensional radiographic bone assessment. Radiographic bone consolidation was defined as continuous trabecular radiopacity without radiolucent defects or clinical signs of infection. Patients were followed for six months post-surgery, with clinical and radiographic evaluations, as well as assessment of oral health-related quality of life (OHIP-14). All 80 patients (mean age: 47.2 ± 18.9 years; 51% male) completed the immediate postoperative assessment. Eleven DDs (granule loss) were observed postoperatively (13.8%) and no AEs. At six months, 71 patients (88.8%) completed follow-up. Radiographic bone repair was confirmed in all cases clinically observed and with follow-up X-ray (100%). No AEs or DDs reported (AE-free rate: 100%) at this follow-up. The median OHIP-14 score improved significantly at six months (p = 0.037), indicating better self-reported oral health. Given the observational design, absence of a control group, and partial reliance on non-radiographic follow-up, these findings should be interpreted with caution. Within these limitations, the synthetic calcium phosphate ceramic demonstrated a favorable short-term safety profile and apparent bidimensional radiographic signs of clinical performance under real-world conditions, rather than definitive evidence of effectiveness. Further controlled studies incorporating histological and volumetric analyses are warranted to confirm its regenerative potential. Full article