Search Results (224)

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

Background: Patient-reported outcome measures (PROMs) are essential for assessing postoperative morbidity and patient-centered treatment value after periodontal plastic surgery. This study evaluated PROMs following the modified coronally advanced tunnel (MCAT) combined with subepithelial connective tissue graft (SCTG) and different adjunctive biomaterials. Methods: This retrospective pooled secondary analysis included 64 patients treated for 275 gingival recessions using MCAT + SCTG with physiological saline (control), 24% EDTA, enamel matrix derivative (EMD), or cross-linked hyaluronic acid (HA). PROMs were the primary outcomes and included postoperative pain and swelling assessed using a 0–100 mm visual analogue scale (VAS), together with binary symptom measures recorded on days 1, 2, 4, 7, and 14. Patient satisfaction, esthetic perception, and willingness to recommend treatment were also assessed. Clinical and esthetic outcomes at 12 months served as reference parameters. Results: Early postoperative pain differed significantly between groups on days 1, 2, and 7 (p = 0.016, 0.024, and 0.033, respectively). Edema also varied significantly on days 2, 4, and 14 (p = 0.011, 0.001, and 0.001, respectively). The HA group showed lower pain scores on days 2 and 4, whereas EDTA was associated with greater early discomfort. Despite these differences, long-term satisfaction, esthetic perception, willingness to recommend treatment, and root coverage outcomes were high and comparable among groups (p > 0.05). Conclusions: MCAT + SCTG provides predictable and stable outcomes for multiple gingival recessions, regardless of adjunctive biomaterial. However, PROMs revealed differences in early postoperative morbidity, supporting their integration into clinical decision-making alongside clinician-reported outcomes. Full article

This single-center, split-mouth, single-blind pilot randomized trial compared patient morbidity, healing and root coverage between the subepithelial connective tissue graft (SCTG) and the de-epithelialized free gingival graft (D-FGG) when combined with the modified coronally advanced tunnel (MCAT) technique in multiple adjacent gingival recessions. Sixteen systemically healthy patients with bilateral Miller Class I/II (Cairo RT1) recessions were enrolled, and contralateral sides were randomly allocated to MCAT + SCTG (control) or MCAT + D-FGG (test) by means of sequentially numbered, opaque, sealed envelopes (SNOSE). Patient-reported outcomes (pain, chewing discomfort, bleeding) and the Landry Healing Index were assessed at 1 and 2 weeks; recession depth, mean root coverage (mRC) and Root Coverage Esthetic Score (RES) were evaluated at 6 months. Both techniques achieved high mRC (test: 94.22% ± 10.28%; control: 94.60% ± 9.99%) and RES (test: 8.02 ± 0.63; control: 8.14 ± 0.77), with no statistically significant intergroup differences. Donor-site pain was significantly lower in the D-FGG group, whereas early chewing discomfort and bleeding were higher. Because the trial was not powered for equivalence or non-inferiority, these preliminary findings are hypothesis-generating and require confirmation in adequately powered trials. Full article

Background: Gingival recession is a common periodontal condition. With the increasing use of artificial intelligence (AI)-based chatbots, patients frequently seek online health information. However, the reliability, accuracy, and readability of AI-generated patient-oriented information on gingival recession remain unclear. Objective: To evaluate the quality, accuracy, and readability of ChatGPT-generated responses to patient-oriented questions related to gingival recession. Methods: A total of 288 patient-oriented questions were developed by an expert panel and categorized into fourteen thematic domains. Responses generated by ChatGPT (version 3.5) were independently evaluated by five oral health professionals using a modified Brief DISCERN instrument, an accuracy scoring system, and the Global Quality Score (GQS). Readability was assessed using the Flesch Reading Ease and Flesch–Kincaid Grade Level indices. Results: Significant differences were observed among thematic categories for DISCERN, accuracy, GQS, and readability scores (all p < 0.01). The highest modified Brief DISCERN, accuracy, and GQS scores were recorded for the Information Sources/AI Reliability category (DISCERN: 19.60 ± 2.29; accuracy: 4.67 ± 0.49; GQS: 4.33 ± 0.49), whereas the lowest scores were observed for the What Happens If Left Untreated? category (DISCERN: 14.27 ± 1.75; accuracy: 3.23 ± 0.43). Strong positive correlations were identified between DISCERN and accuracy (r = 0.784, p < 0.001) and between accuracy and GQS (r = 0.868, p < 0.001). Readability indices were not significantly correlated with accuracy or quality measures. Conclusions: ChatGPT provided patient-oriented information on gingival recession with variable performance across thematic domains; however, readability remained a limitation. AI-generated content should therefore be considered a supplementary resource rather than a substitute for clinician-guided patient communication. Full article

Maxillary canine impaction is a common clinical condition often requiring a combined surgical–orthodontic approach; however, the effect of different surgical strategies on periodontal outcomes remains unclear. This systematic review aimed to evaluate periodontal outcomes following treatment of impacted maxillary canines, with particular focus on the influence of surgical technique (open vs. closed) and impaction site (palatal vs. buccal). A comprehensive search of PubMed, Scopus, and Web of Science was conducted up to January 2026 in accordance with PRISMA guidelines, and the protocol was registered in PROSPERO. Randomized controlled trials, controlled clinical studies, observational studies, case series, and case reports reporting periodontal parameters were included. Primary outcomes comprised probing pocket depth, keratinized tissue width, gingival thickness, plaque and bleeding indices, and gingival recession. Twenty-seven studies were included. Overall, treated canines were associated with periodontal conditions comparable to normally erupted teeth, with probing depths generally within physiological limits and minimal gingival recession. Buccally impacted canines tended to show slightly reduced keratinized tissue compared with palatal impactions, although without clear clinical relevance. No consistent superiority of open or closed techniques was identified. Surgical–orthodontic treatment is generally associated with favorable periodontal outcomes, and treatment selection should be individualized according to anatomical and orthodontic factors. Full article

Background/Objectives: A non-surgical orthodontic treatment strategy for transverse maxillary deficiencies, especially in late adolescents and young adults, is microscrew-assisted rapid palatal expansion (MARPE). The literature indicates several concerns regarding its long-term efficacy and potential complications. Recent studies have provided valuable insights into the MARPE technique, particularly focusing on its efficacy, potential complications, and treatment failures. The present scoping review aims to synthesize and critically appraise clinical evidence on MARPE in post-pubertal patients, with a specific focus on treatment outcomes, mechanisms of failure, and local and systemic adverse effects to inform risk–benefit assessment and clinical decision-making. Methods: A systematic search was conducted across four electronic databases (PubMed, EMBASE, Scopus, and Cochrane Library) to identify English-language clinical trials, observational studies, and systematic reviews published between January 2015 and December 2025. The search strategy employed controlled vocabulary (MeSH terms) and Boolean operators targeting MARPE, treatment failure, and adverse effects in patients aged ≥ 16 years. After title/abstract screening and full-text assessment using predetermined inclusion criteria, 15 studies (3 systematic reviews with meta-analysis, 2 umbrella reviews, 4 systematic/scoping reviews, 2 randomized controlled trials, and 4 observational studies) were selected for qualitative synthesis. Results: Fifteen studies were finally included, which demonstrated significant heterogeneity in methodological design, sample characteristics, outcome measurement protocols, and MARPE device specifications. Mean success rates of 92.5% for maxillary transverse expansion were reported, with mean expansion duration ranging between 20 and 126 days. Key adverse effects comprised dentoalveolar tipping (buccal inclination of maxillary molars and premolars), periodontal complications (buccal bone resorption of 0.6–0.9 mm, gingival recession, papilla recession in 18% of cases), root resorption, miniscrew loosening, midpalatine/circummaxillary sutures, and potential but minimally documented intracranial effects. Conclusions: MARPE appears to be a valid non-surgical option for selected post-pubertal patients, but its success depends on careful case selection and monitoring for dentoalveolar, periodontal, sutural, and rare intracranial adverse effects. Full article

Gingival recession is commonly linked to alveolar bone dehiscence, inflammatory burden, traumatic brushing, or excessive orthodontic forces. However, recession is also observed in some patients despite apparently mild or “biologically acceptable” loading, particularly in thin periodontal phenotypes. Here, we propose the Gingival Creep Failure Theory, a hypothesis-driven conceptual framework in which gingival soft tissues undergo time-dependent viscoelastic deformation (creep) under sustained or repetitive tensile microstrain. Over time, accumulated deformation and microstructural fatigue may reduce recoil capacity and shift the gingival margin apically once tissue-level tolerance is exceeded. Gingival connective tissue is modeled as a fiber-reinforced, fluid-rich viscoelastic composite whose response depends on collagen architecture, cross-linking, proteoglycan-mediated hydration, and vascular support. In thin phenotypes characterized by reduced connective tissue volume and altered extracellular matrix (ECM) organization, creep progression is hypothesized to accelerate, lowering the threshold at which fatigue-related microdamage translates into clinically detectable marginal migration. Evidence from collagenous connective tissue biomechanics supports the plausibility that sub-failure sustained or cyclic loading can produce cumulative deformation and incomplete recovery; however, direct creep–fatigue data for human gingiva remain limited, underscoring the need for targeted validation studies. This hypothesis integrates soft tissue mechanics with periodontal phenotype biology and orthodontic loading patterns and proposes creep and microstructural fatigue as plausible time-dependent contributors to gingival recession in susceptible phenotypes. Because direct in vivo gingival strain and creep–fatigue measurements remain limited, the model should be interpreted as hypothesis-generating and in need of targeted clinical and experimental validation. Full article

Background: The attached gingiva (AG) is the portion of the gingiva firmly bound to the underlying alveolar bone and root cementum, rendering it immobile during functioning. Its dense connective tissue attachment contributes to resistance against mechanical challenges, stabilization of the gingival margin, and dissipation of forces transmitted from the alveolar mucosa. Histologically, AG is characterized by a keratinized epithelium supported by dense collagen fiber bundles, which provide structural integrity to the dento–gingival unit. Clinically, the buccal and lingual width of AG is estimated by subtracting sulcus depth from the total width of keratinized tissue. Although periodontal health may be maintained with minimal AG under optimal plaque control, substantial evidence supports its role in preserving gingival architecture and resisting mechanical trauma. Practical Application: From a clinical perspective, an adequate width of attached gingiva has traditionally been considered necessary to protect the periodontium; however, clinical situations may exist in which its dimension is reduced or absent. Available evidence suggests that a minimal width of approximately 1 mm of attached gingiva may be sufficient to maintain periodontal health under conditions of effective plaque control and absence of inflammation. Nevertheless, when only this minimal dimension is present, the attachment is predominantly derived from the junctional epithelium, which may offer limited mechanical protection to the dento–gingival unit. Within the limits of current evidence, a keratinized tissue width of approximately 3 mm appears to represent a functional threshold associated with increased connective tissue fiber density and enhanced resistance to mechanical trauma. Methods: A narrative review of classical and contemporary literature was conducted to evaluate the morphology, histology, function, and clinical relevance of the attached gingiva. Results: Evidence indicates that when AG width is minimal, reliance on junctional epithelial attachment alone provides limited resistance to mechanical challenges. In contrast, a greater width of AG incorporating connective tissue fiber attachment is associated with improved gingival margin stability, enhanced mechanical protection, and periodontal tissue resilience. Based on this synthesis, a tissue-based clinical categorization of AG is proposed. Conclusions: This review integrates current biological and clinical concepts regarding the functional dimensions of attached gingiva. The proposed categorization offers a practical framework to support clinical decision-making and to identify conditions in which surgical augmentation may be indicated for the management of mucogingival deficiencies. Full article

Background and Objectives: Combined orthodontic–orthognathic treatment is the standard approach for managing severe dentofacial deformities. Nevertheless, its potential impact on periodontal tissues, particularly gingival recession (GR), remains a matter of clinical concern. This study aimed to evaluate the relationship between orthodontic–orthognathic procedures and GR based on available clinical evidence, with particular focus on potential risk modifiers, including orthodontic mechanics, surgical factors, and periodontal phenotype. Materials and Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The review question was formulated using the PICO framework. Results: Seven observational clinical studies were included, with sample sizes ranging from 24 to 40 patients. GR outcomes varied considerably according to surgical procedure, orthodontic mechanics, adjunctive therapies, and patient-specific factors. Overall certainty of evidence was low–moderate. Conclusions: GR following combined orthodontic–orthognathic treatment is inconsistently reported and influenced by multiple clinical variables. Evidence suggesting roles for periodontal phenotype and adjunctive therapies, including PAOO, remains limited and context-dependent. Overall certainty of evidence is low–moderate, and findings should be interpreted cautiously. Full article

In implant treatment in the aesthetic zone, high aesthetic quality is required in addition to functionality and long-term stability when reconstructing defects in peri-implant tissues. Post-traumatic cases often present with extensive loss of both hard and soft tissues, making the selection of an appropriate grafting method essential. This report describes a case in which an interpositional gingival graft (IGG) and a strip gingival graft (SGG) were combined to regenerate peri-implant soft tissue following guided bone regeneration (GBR), maintaining favorable tissue morphology and aesthetics for six years. The patient was a 53-year-old woman who suffered trauma after falling down stairs, resulting in a fractured bridge in the right maxillary canine region and crown fracture. The traumatized tooth was extracted, and GBR was performed to restore hard tissue volume. Subsequently, IGG and SGG were used to improve soft tissue thickness, interproximal papilla height, and a healthy mucogingival junction (MGJ). A cantilever implant prosthesis was selected as the final restoration. Over six years, no gingival recession or marginal bone loss was observed, and excellent aesthetic stability was maintained. A mini-review of published reports on IGG and SGG demonstrated their efficacy in enhancing soft tissue volume. The findings of this case suggest that a comprehensive approach—including bone augmentation, soft tissue grafting, and prosthetic design—can provide predictable, long-term aesthetic and functional outcomes in complex post-traumatic cases (223). Full article

Background and Objectives: Gingival recession (GR) is a recognized periodontal condition that can expose the tooth root, imposing aesthetic, functional, and hypersensitivity concerns. We conducted this study to investigate xenogenic soft tissue substitutes as potential alternatives to the gold standard connective tissue graft (CTG) for the treatment of multiple GR. Materials and Methods: This systematic review and meta-analysis adhered to PRISMA guidelines and was registered in PROSPERO. A comprehensive search of PubMed, Web of Science, Scopus, and the Cochrane Library was conducted until October 2025 for randomized controlled trials (RCTs) comparing connective tissue graft (CTG) to xenogeneic substitutes (XCM or P-XADM) for treating multiple gingival recessions. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the RoB 2 tool, 2019 version. Data were pooled using a random-effects model to calculate mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI) for primary (mean root coverage, MRC; complete root coverage, CRC) and secondary outcomes (clinical attachment level, CAL; keratinized tissue width, KTW; gingival thickness, GT; probing depth, PD). Results: Sixteen RCTs (632 patients, 1878 recessions) were included. At 6 and 12 months, CTG demonstrated a significantly greater MRC than both XCM (MD −13.4% and −11.05%) and P-XADM (MD −11.63% at 12 months). CTG was also superior to XCM in achieving CRC at 6 months (RR = 0.71, 95% CI [0.62 to 0.82]). For secondary outcomes, CTG showed superior gains in CAL and KTW at 12 months compared with both xenogeneic materials. GT was significantly greater in the CTG than in the XCM group in 12 months. No significant differences were found in PD at all time points. Conclusions: CTG continues to have superior clinical outcomes in the treatment of multiple GR. However, xenogenic materials are a promising alternative, particularly when patient comfort and satisfaction are prioritized. Future well-designed trials with larger sample sizes and standardized outcomes are needed to validate their clinical benefits and long-term stability. Full article

Background: Periodontal disease is a chronic multifactorial inflammatory condition caused by dysbiosis of the dental biofilm, leading to destruction of the connective tissue attachment, alveolar bone resorption, and potentially tooth loss. Non-surgical periodontal therapy (NSPT), involving subgingival instrumentation, aims to restore periodontal health by reducing the probing pocket depth (PPD) and bleeding on probing (BOP) and by improving the clinical attachment level (CAL). The adjunctive use of chemical agents, such as sodium hypochlorite/amino acids (NaOCl) and cross-linked hyaluronic acid (xHyA) gels, has been proposed to enhance the efficacy of NSPT. Objective: This systematic review aimed to evaluate the clinical effectiveness of the subgingival application of NaOCl and xHyA gels as adjunctive therapies to NSPT in patients with periodontal disease. Materials and Methods: A comprehensive literature search was conducted in the MEDLINE (PubMed), Cochrane Library, Web of Science, and Scopus databases following PRISMA guidelines. The review was registered in PROSPERO (CRD420251074045). Randomized clinical trials (RCTs) in human subjects with a follow-up of at least 6 months were included if they assessed outcomes such as PPD, CAL, BOP, or radiographic bone loss (RBL). Studies involving the adjunctive use of NaOCl and xHyA gels were selected according to the PICOS strategy. Results: Two RCTs published between 2023 and 2024, with follow-ups ranging from 6 to 9 months and involving 48–50 patients, met the inclusion criteria. Both studies demonstrated significant improvements in clinical outcomes when sodium hypochlorite and hyaluronic acid were used adjunctively with NSPT compared to when NSPT was used alone. Sites treated with adjunctive therapy showed significantly greater reductions in PPD and greater CAL gains over time. Pocket closure rates were also markedly higher in deep sites (>7 mm) in the adjunctive group than in the control group, indicating a substantial regenerative potential and a possible reduction in the need for surgical intervention. Gingival recession exhibited more favorable recovery trends in the adjunctive group, while BOP frequency decreased in both groups without statistically significant differences. Conclusions: The adjunctive use of NaOCl and xHyA gels in non-surgical periodontal therapy significantly enhances clinical outcomes compared with the use of mechanical debridement alone. Full article

Objectives: Post-extraction remodelling of hard and soft tissues results in volume reduction, leading to aesthetic challenges in planning prosthetic restorations, particularly in the anterior maxilla. This study assessed whether atraumatic vertical extraction, versus conventional extraction, could reduce postoperative volume loss and aesthetic compromises at the extraction site and adjacent teeth. Methods: Following randomized tooth extraction with unassisted healing in the test (Benex^® extraction, n = 10) and control group (conventional extraction, n = 10), postoperative scans were conducted at 30 days (t₁), 60 days (t₂), 90 days (t₃) and 12 months (t₄). Each scan was aligned with the baseline scan (t₀), and surface comparison was performed with five regions of interest (ROIs: central, mesial, distal, papilla mesial and papilla distal). Aesthetic parameters, including recession and Pink Esthetic Score (PES) of adjacent teeth, were clinically evaluated at each follow-up appointment. Statistical analysis used a mixed linear model accounting for confounding factors such as smoking, buccal bone integrity, gingival phenotype, and provisional use. Results: Both groups showed significant volume reduction from baseline to t₃ and t₄. The largest volume loss occurred in the central ROI in both test (t₄: −65.34 ± 36.89 mm³) and control group (t₄: −70.85 ± 30.96 mm³), with no significant difference between groups. A decline in PES and recession at the adjacent teeth was noted in both groups at 12 months. Conclusions: Both groups showed significant volume reduction with aesthetic impairment at the adjacent teeth’s soft tissue. Full article

Gingival recession, particularly in patients exhibiting a thin periodontal phenotype, is a prevalent and challenging complication associated with orthodontic treatment, among other factors. Recent advances in biostimulation therapies aim to support soft tissue augmentation by increasing gingival thickness (GT) and keratinized tissue width (KTW) while minimizing the need for invasive surgical procedures. This narrative review explores the available clinical evidence regarding several biostimulation techniques, including injectable platelet-rich fibrin (i-PRF), microneedling (MN), concentrated growth factors (CGF), atelocollagen, hyaluronic acid (HA), and low-level laser therapy (LLLT), with a particular focus on their potential adjunctive role in orthodontic patients with a thin periodontal phenotype. While i-PRF and microneedling—used alone or in combination—have shown promising short-term soft tissue thickening and reduced patient morbidity when compared with conventional grafting procedures, the available evidence is largely derived from small, randomized trials, pilot studies, and non-orthodontic cohorts, limiting the strength of comparative conclusions. Minimally invasive biostimulation techniques may represent potential adjunctive strategies for soft tissue management in selected clinical scenarios. Nevertheless, current evidence remains limited and heterogeneous, and robust, long-term, orthodontic-specific clinical trials are required before these approaches can be considered reliable alternatives to established surgical protocols or validated preventive strategies against gingival recession. Full article

Background: The predictability of regenerative outcomes in non-contained intrabony periodontal defects remains limited. Autogenous tooth bone grafts (ATB) may represent a biologically active and osteoconductive scaffold with minimal residual graft material. This study evaluated the clinical and radiographic outcomes of ATB combined with enamel matrix derivative (EMD) in intrabony defects. Methods: Nine systemically healthy patients (15 defects) were treated with ATB + EMD in a retrospective proof-of-concept design. Clinical parameters—probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (GR)—were recorded at baseline and 6 months. Radiographic changes in defect depth and width were also assessed. Statistical significance was set at p < 0.05. Results: Mean PPD decreased from 7.73 ± 0.96 mm to 3.87 ± 0.74 mm (p < 0.001), and CAL improved from 9.20 ± 1.47 mm to 5.53 ± 1.36 mm (p < 0.001). GR changes were not significant. Radiographically, mean defect depth and width were reduced from 3.81 ± 1.59 mm and 2.56 ± 0.75 mm to 0.72 ± 1.08 mm and 0.44 ± 0.70 mm, respectively (p < 0.001). Conclusions: The combination of ATB and EMD yielded substantial clinical and radiographic improvements in intrabony periodontal defects. These findings suggest that autogenous tooth bone grafts may serve as a reliable biologically active scaffold for regenerative periodontal surgery. This is the first study evaluating the combination of EMD and ATB. Within the study limitations, ATB + EMD demonstrated promising regenerative potential, warranting future controlled clinical trials. Full article