Search Results (574)

Guided Bone Regeneration (GBR) is a pivotal technique in dental and orthopedic applications for regenerating bone in areas of deficiency. Natural polymers such as collagen, chitosan, alginate, and gelatin have emerged as essential materials in GBR due to their biocompatibility, biodegradability, and bioactivity. These polymers not only provide a scaffold for bone regeneration but also support cellular adhesion, proliferation, and differentiation. Despite their benefits, challenges such as variable degradation rates, insufficient mechanical strength, and limited bioactivity hinder their optimal clinical use. To address these limitations, ongoing research focuses on enhancing the properties of natural polymers. Composite materials combining fast- and slow-degrading polymers are being developed to achieve consistent degradation rates. Surface modifications, including nanoscale texturing and growth factor coatings, are improving bioactivity. Nanotechnology further enhances the structural and therapeutic potential of GBR materials, while advancements in 3D bioprinting enable the creation of customized scaffolds with precise architecture. These innovations aim to bridge the gap between biological compatibility and clinical functionality, making natural polymers more adaptable and effective in GBR. This review highlights the mechanisms, challenges, and advancements in natural polymers for GBR, emphasizing their potential to transform bone regeneration into a more reliable and patient-centered approach. Full article

Repairing large bone defects remains a clinical challenge in orthopedics. Near-infrared (NIR) photothermal therapy (PTT) has recently expanded from high-temperature tumor ablation to the field of mild bone regeneration. Maintaining temperatures within a mild window of 40–42 °C accelerates bone healing by activating osteogenic signals, modulating the immune microenvironment, and providing antibacterial effects. It is important to note that the therapeutic efficacy is highly dependent on the precise control of both temperature and exposure duration: temperatures exceeding 42–43 °C can induce cell apoptosis, while temperatures above 45 °C typically cause necrosis. The reviewed studies employed controlled exposure times (typically 5–15 min per session) to maintain cell viability above 85%, with functional assessments confirming preserved osteogenic differentiation capacity of bone marrow-derived mesenchymal stem cells (BMSCs) and maintained macrophage plasticity after mild photothermal treatment. This performance depends on photothermal conversion materials. This paper reviews the applications of MXene, black phosphorus (BP), polydopamine/graphene oxide (PDA/GO), and metal-based nanomaterials in bone repair. We also analyze photothermal-based immune regulation, sequential repair strategies, and tumor theranostics. Finally, we discuss current challenges and future trends to guide the design of next-generation smart bone repair materials. Full article

Bone regeneration is governed by a tightly coordinated interplay between skeletal cells, immune cells, vascular components, and signaling networks within a dynamic microenvironment. Increasing evidence from osteoimmunology demonstrates that immune regulation is not merely supportive but mechanistically determinative of regenerative outcomes. Dysregulated or persistent inflammation can impair osteogenesis, whereas timely immune resolution promotes angiogenesis and matrix deposition. In this context, nanotechnology has enabled the development of nanoparticles (NPs) that function not only as delivery vehicles but also as active modulators of the bone immune microenvironment. Immunomodulatory NPs can be engineered to deliver bioactive agents, regulate cytokine networks, and influence immune cell phenotypes, particularly macrophage polarization, at defined stages of healing. Through tailored surface chemistry, targeting ligands, and stimuli-responsive release mechanisms, NPs can achieve spatially localized and temporally controlled modulation of inflammatory and reparative phases, thereby enhancing osteogenesis and vascular integration. This review provides a comprehensive overview of organic, inorganic, and hybrid NP platforms applied to bone regeneration, with emphasis on their mechanisms of immune modulation, strategies for cell-specific targeting, and approaches for sequential regulation of inflammatory resolution and tissue repair. By integrating advances in materials science and immunology, NP-enabled platforms have the potential to transform bone regeneration from passive structural repair into precision immune-guided healing. 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

Vascular–osteogenic coupling plays a central regulatory role in bone regeneration, but it is frequently impaired under pathological conditions, including aging, ischemia, and chronic inflammation, which compromises efficient bone repair. Gelatin methacryloyl (GelMA) hydrogels, which combine extracellular matrix-like bioactivity, adjustable mechanical properties, and compatibility with three-dimensional biomanufacturing, have become a widely used material platform for vascularized bone regeneration. From the perspective of vascular–osteogenic coupling, this review reframes and synthesizes GelMA-based approaches for vascularized bone regeneration, grouping existing strategies into three categories: (i) intrinsic material design, in which pore architecture, microchannels, dynamic networks, and interfacial functionalization are used to guide vascular ingrowth; (ii) exogenous bioactive delivery, involving growth factors, extracellular vesicles, cells, and inorganic ions to enhance vascularization; and (iii) smart responsive strategies, including ROS/pH-responsive systems, sequential release, and external stimulation, which aim to recapitulate the evolving microenvironment during bone repair. This review further compares these strategies in terms of evidence level, reproducibility, and translational potential. Exogenous delivery systems currently have the strongest preclinical support, but issues related to dose standardization, burst release, and long-term safety remain unresolved. Intrinsic material programming is less extensively studied, yet may be more compatible with manufacturing consistency, sterilization, and engineering translation. Most stimuli-responsive systems, by contrast, remain largely at the small-animal or proof-of-concept stage. Future GelMA-based systems should therefore shift from increasing functional complexity toward improving predictability, reproducibility, and clinical feasibility. Compositionally defined and structurally controllable GelMA composites that integrate vascular regulation with mechanical support may provide a more realistic path for vascularized bone regeneration. Full article

Background and Clinical Significance: Severe skeletal Class II malocclusion associated with periodontal compromise and posterior edentulism requires a carefully sequenced interdisciplinary treatment approach integrating orthodontic, surgical, periodontal, and prosthetic rehabilitation. Case Presentation: This case report describes the comprehensive interdisciplinary management of a 21-year-old female patient presenting with skeletal Class II malocclusion, severe mandibular retrognathia, vertical maxillary excess, labial incompetence, temporomandibular joint (TMJ) dysfunction and periodontal deficiencies. The treatment sequence involved occlusal splint therapy, pre-surgical orthodontic decompensation, bimaxillary orthognathic surgery using a segmental Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO), postoperative orthodontic refinement with aligners, periodontal plastic surgery using the Zucchelli technique and guided bone regeneration (GBR) with implant placement in the posterior mandible. At the four-year follow-up, the patient demonstrated complete root coverage, stable skeletal correction, and satisfactory implant integration, with maintenance of functional and aesthetic outcomes over time. Conclusions: This report highlights the importance of precise preoperative planning and the synergy between orthodontics, orthognathic surgery and periodontics in achieving optimal functional and aesthetic results. Full article

Background: Large segmental bone defects remain a major challenge in reconstructive surgery, particularly in the presence of impaired vascularization. Despite advances in scaffold design and biomaterials, insufficient vascular supply continues to represent the primary limitation in bone tissue engineering, often leading to impaired osteogenesis and graft failure. Objective: This review aims to analyze the role of vascularized flaps as “living bioreactors” in bone tissue engineering, focusing on their capacity to enhance scaffold vascularization, support osteogenesis, and facilitate clinical translation. Methods: A narrative review was conducted through a structured search of PubMed, Scopus, and Web of Science using combinations of the following keywords: “bone tissue engineering”, “vascularized flaps”, “arteriovenous loop”, and “in vivo bioreactor”. Relevant preclinical and clinical studies were selected based on their contribution to vascularization strategies in scaffold-based bone regeneration, with the aim of illustrating the evolution and integration of these approaches. Results: Vascularized flaps provide an established vascular network and a biologically active microenvironment that promote scaffold integration and tissue regeneration. Periosteal flaps demonstrate strong osteogenic potential, whereas muscle and omental flaps primarily act as vascular carriers and adaptable regenerative environments. AV loop-based strategies enable intrinsic axial vascularization, ensuring rapid and homogeneous perfusion of large constructs. Hybrid approaches, including regenerative matching axial vascularization (RMAV), integrate vascularized tissues with advanced biomaterials and show promising translational outcomes. Conclusions: Vascularization-driven strategies represent a paradigm shift in bone tissue engineering, moving from passive scaffold implantation to actively engineered, vascularized constructs. The integration of microsurgical techniques with advanced biomaterials offers significant potential for the development of personalized and clinically applicable bone regeneration strategies. Full article

Background/Objectives: We report a case of severe dermatomyositis demonstrating characteristic widespread extraosseous uptake on ^99mTc-methylene diphosphonate (^99mTc-MDP) bone scintigraphy. This study highlights the diagnostic value of this modality in detecting active inflammatory myopathy when conventional muscle biopsy is inconclusive and introduces its novel use for intraoperative gamma-probe-guided biopsy to precisely target metabolically active muscle. This approach may help target metabolically active muscle in heterogeneous idiopathic inflammatory myopathies (IIMs). Case Presentation: A 49-year-old man developed progressive proximal muscle weakness (Medical Research Council grade 2/5 proximally, 5/5 distally) beginning in June 2025 following influenza infection, accompanied by dysphagia, classic dermatomyositis cutaneous manifestations, back pain, and difficulty standing. Laboratory evaluation revealed elevated inflammatory markers (ESR 55 mm/hr, CRP 20 mg/L), leukocytosis (16.58 × 10⁹/L), markedly raised creatine kinase (19,937 IU/L), and troponin T levels. An initial quadriceps muscle biopsy performed on 29 July 2025 was non-diagnostic. Three-phase ^99mTc-MDP scintigraphy (~1110 MBq) demonstrated intense, diffuse extraosseous uptake involving bilateral deltoids (symmetric), biceps and triceps (patchy), paraspinal muscles (longitudinal), gluteal muscles, thighs (quadriceps and hamstrings), and gastrocnemius muscles, with relative suppression of appendicular skeletal uptake on delayed images due to soft-tissue tracer dominance—findings consistent with severe inflammatory myopathy. Following reinjection (~1100 MBq), intraoperative gamma-probe-guided biopsy targeted areas of highest uptake (left quadriceps femoris and distal triceps brachii; intraoperative counts 1300–1400 versus background ~500). Histopathology revealed histiocyte-predominant inflammation with myofibre necrosis and regeneration, sparse CD4⁺ T-cell infiltrates, and absence of fibrosis, consistent with necrotising myopathy. Positive antinuclear antibodies and strong anti-Mi-2 antibodies confirmed the diagnosis of dermatomyositis. Treatment included pulse methylprednisolone followed by oral prednisone taper, methotrexate, azathioprine, intravenous immunoglobulin, and planned rituximab therapy. Discussion: Whole-body ^99mTc-MDP scintigraphy provided a complementary whole-body functional assessment of disease extent, revealing widespread muscular involvement. The novel application of intraoperative gamma-probe-guided biopsy enabled real-time targeting of metabolically active muscle, facilitating targeted sampling after an initial non-diagnostic biopsy and yielding supportive histopathological findings. This dual diagnostic and interventional role demonstrates the technical feasibility of gamma-probe guidance in a diagnostically challenging case of dermatomyositis. Conclusions: In our case, the integration of ^99mTc-MDP scintigraphy with gamma-probe-guided biopsy enabled precise targeting of metabolically active muscle following an initial non-diagnostic biopsy. This multimodal approach may be useful in selected diagnostically challenging cases of severe inflammatory myopathy. Larger studies are needed to evaluate its reproducibility and added value. Full article

Background/Objectives: Contemporary implant dentistry is increasingly oriented toward minimally invasive regenerative strategies designed to reduce surgical morbidity while preserving or improving clinical outcomes. Conventional bone augmentation procedures remain effective and biologically well established, but they may be associated with greater patient burden, increased risk of complications, and higher technical demands in selected clinical scenarios. This narrative review critically examines minimally invasive bone regeneration approaches in implant dentistry, with particular focus on the Bone Core Technique, the Sub-Periosteal Peri-implant Augmented Layer (SPAL) technique, and Immediate Dentoalveolar Restoration (IDR), emphasizing their biological rationale, clinical indications, surgical workflows, limitations, and reported outcomes. Methods: A structured, non-systematic literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science to identify publications relevant to minimally invasive bone regeneration in implant dentistry. Priority was given to clinical studies, prospective cohorts, case series, technical descriptions, and biologically oriented conceptual papers addressing vascular preservation, flap limitation, donor-site morbidity, and peri-implant hard- and soft-tissue integration. Results: Available evidence suggests that minimally invasive regenerative protocols may offer favorable clinical and patient-centered outcomes only in carefully selected indications and when performed by experienced operators. The strength of support is uneven across techniques: the Bone Core Technique currently has the strongest dedicated prospective follow-up for localized peri-implant defects, SPAL is supported by limited retrospective and emerging histologic evidence, and IDR remains largely based on case reports, technique-driven descriptions, and broader immediate implant literature. Conclusions: Minimally invasive bone regeneration reflects a shift toward biologically guided and patient-centered treatment concepts in implant dentistry, but it should not be interpreted as a universal substitute for conventional augmentation. Its successful application depends on careful case selection, sound knowledge of wound healing and defect morphology, and advanced surgical and prosthetic expertise. Further research should prioritize standardized outcome measures, longer follow-up, and comparative prospective studies. Full article

Background/Objectives: The aim of this study was to compare the augmentation stability and clinical outcomes of L-shaped collagenated soft block bone substitutes (BBS) used in combination with either a self-assembly technology (SAT)-based physically crosslinked resorbable collagen membrane (RCM) or a conventional non-crosslinked RCM for peri-implant dehiscence defects. Methods: This retrospective cohort study included 30 patients who underwent guided bone regeneration (GBR) with simultaneous implant placement. The patients were treated with either a physically crosslinked membrane (PCM group, n = 15) or a non-crosslinked membrane (NCM group, n = 15). Clinical, radiographic, and profilometric parameters were evaluated at baseline, immediately post-GBR, and at re-entry surgery. Early wound healing complications and patient-reported outcomes were also assessed. Results: Both groups achieved significant defect resolution without severe adverse events. The mean reductions in defect width and height were 4.47 ± 1.82 mm (92.9%) and 4.07 ± 2.19 mm (89.4%) in the PCM group and 3.80 ± 1.59 mm (89.5%) and 4.13 ± 1.64 mm (86.9%) in the NCM group, respectively. Both groups showed comparable dimensional changes in hard and soft tissues, with no statistically significant differences in radiographic or profilometric outcomes. The incidence of wound healing complications, as well as patient-reported postoperative pain and swelling, were similar between the groups. Conclusions: Within the limitations of this retrospective pilot cohort study, SAT-based physically crosslinked RCMs used in combination with L-shaped soft BBS demonstrated clinical, radiographic, profilometric, and patient-reported outcomes similar to those observed with conventional non-crosslinked RCMs, without major short-term postoperative complications. These preliminary findings suggest that SAT-based RCMs may represent a feasible membrane option for GBR; however, these findings should be interpreted as preliminary and hypothesis-generating and should be confirmed in larger, adequately powered prospective clinical studies. Full article

Background: Osteoinduction and bone regeneration are fundamental biological mechanisms enabling osseointegration and long-term durability of endosseous dental implants. In clinical practice, poor bone conditions, aesthetic demands, and peri-implant soft tissue problems commonly need the utilization of regenerative techniques targeted at optimizing both hard and soft tissue results. The purpose of this narrative review was to examine osteo-inductive and regenerative strategies currently employed in implant dentistry, with particular emphasis on the mechanobiological integration of hard–soft tissue regeneration and its implications for peri-implant tissue stability, osseointegration, and clinical predictability. Methods: A narrative literature review was done using PubMed and Scopus databases. Based on predetermined inclusion and exclusion criteria, studies published in English during the previous five years were reviewed. The core narrative analysis comprised a selection of physiologically relevant research that addressed osteo-inductive techniques, bone regeneration, osseointegration, and peri-implant soft tissue outcomes, as well as clinical studies, randomized controlled trials, systematic reviews, and narrative reviews. A narrative synthesis was carried out because of methodological variability. Special emphasis was placed on evidence addressing the biological and clinical interaction between hard- and soft-tissue regenerative strategies, reflecting the specific conceptual focus of the review. Results: The evidence presented suggests that implant surface biofunctionalization, biologically active grafting materials, guided bone regeneration, and supplementary biological treatments may have a favorable impact on implant stability and peri-implant bone healing. Several investigations also underlined the biological dependency between peri-implant bone regeneration and soft tissue architecture, stressing the significance of soft tissue thickness, keratinized mucosa, and emergence profile stability. Even in inflammatory environments, bioactive titanium surface changes showed osteogenic potential, indicating a supporting function in early osseointegration. Conclusions: By promoting osseointegration and improving peri-implant tissue outcomes, osteo-inductive and regenerative techniques are essential to modern implant dentistry; however, their greatest potential may lie in integrated hard–soft tissue regenerative approaches aimed at improving long-term clinical predictability. To further understand the clinical efficacy of combination hard–soft tissue regeneration methods, future well-designed clinical trials with standardized outcome measures are needed. Future research should further clarify the mechanobiological principles underlying these integrated regenerative approaches. Full article

Background/Objectives: Guided bone regeneration (GBR) in dental applications requires scaffolds that possess balanced mechanical strength, controlled biodegradability, and excellent biological performance; therefore, this study aims to develop and evaluate a multilayered biofunctional dental membrane designed to enhance mechanical, biological, and antibacterial performance. Methods: The multilayered membrane was fabricated using sequential electrospinning and electrospraying techniques to form a polycaprolactone (PCL)/Collagen first layer and a polyvinyl alcohol (PVA)/Collagen/Hydroxyapatite (HAp) second layer, topped with a final electrospray coating of PVA/Amoxicillin. Characterization was performed via SEM, FTIR, and EDS, followed by evaluations of tensile properties, swelling behavior, hydrolytic degradation, in vitro drug release, disk diffusion antibacterial activity against Staphylococcus aureus and Escherichia coli, and 7-day L929 fibroblast cytocompatibility (ANOVA/Tukey, p < 0.05). Results: SEM, FTIR, and EDS analyses confirmed uniform nanofiber morphology, homogeneous HAp distribution, and successful integration of bioactive compounds. The membrane exhibited a maximum tensile strength of 15.17 N, strain of 25.24%, and stress of 2.16 MPa, while swelling reached ~100% within 2 h and degradation stabilized around 4% weight loss after 48 h. Drug release profiles showed a rapid amoxicillin release in the first 50 min, plateauing at approximately 4.5 mg/L by 350 min, with distinct antibacterial inhibition zones, and the PCL/Col–PVA/Col/HAp–PVA/Amox group demonstrated the highest cell viability (~140%) after 7 days, significantly exceeding the control groups (p < 0.01). Conclusions: These quantitative findings validate the fabricated multilayered membrane’s potential as a mechanically robust, biodegradable, antibacterial, and bioactive scaffold for advanced guided bone regeneration in dental applications. Full article

Full-arch implant-supported rehabilitations are widely recognized as an effective treatment option for edentulous patients. Nevertheless, clinical decision-making regarding patient selection, surgical planning, prosthetic material choice, and long-term maintenance protocols remains heterogeneous and requires structured evidence-based guidance. A modified Delphi consensus process was conducted involving 29 experts during the Italian Consensus Conference. A systematic literature review covering the period 2015–2024 was performed, and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Consensus was predefined as ≥90% agreement. Seven evidence-based consensus statements were developed addressing: (1) periodontal risk assessment using validated tools; (2) guided bone regeneration outcomes with technique-specific indications; (3) comparative survival of four versus six implants in mandibular full-arch rehabilitations; (4) equivalence of tilted and axial implant configurations; (5) prosthetic material selection, with monolithic zirconia showing high survival; (6) risk-stratified supportive maintenance protocols associated with a reduction in peri-implantitis incidence; and (7) systemic risk stratification, including absolute and relative contraindications, medication-related osteonecrosis of the jaw (MRONJ) risk management, and perioperative antibiotic prophylaxis. Full article