Search Results (39)

Periodontal diseases in pediatric subjects represent a challenging and relatively underexplored area compared to the extensive data available about periodontal diseases in adults. The present narrative review aims to explore the periodontal status and the related subgingival and/or salivary microbial profiles in pediatric subjects (≤18 years), focusing also on the state of health or systemic diseases. In healthy periodontium, early colonizers, such as Streptococcus and Actinomyces spp., dominate the subgingival microbiota, supporting an eubiosis state. Low levels of Candida albicans and latent Herpesviridae may be detected. In gingivitis, the microbial profile shifts towards more pathogenic species, including Prevotella intermedia and Fusobacterium nucleatum. In necrotizing gingivitis, typically affecting systemically compromised children, the microbial profile is characterized by spirochetes, Fusobacterium, and Prevotella intermedia. Viral coinfections—especially with HSV, CMV, and EBV—are more frequently detected. In periodontitis, the microbiota was dominated by red complex pathogens along with Aggregatibacter actinomycetemcomitans in the aggressive forms, especially in systemically compromised children, as Herpesviridae reactivation and co-infections. Fungal involvement is less well characterized; Candida albicans may be present, particularly in cases of severe immune suppression. Nevertheless, the lack of pediatric longitudinal studies investigating periodontal disease progression after periodontal treatment and related changes in microbiological composition limited the understanding and exploration of the oral microbiota over time. Full article

Dens invaginatus is a developmental dental anomaly characterized by the infolding of the enamel organ into the dental papilla during early odontogenesis. This process leads to a broad spectrum of anatomical variations, ranging from minor enamel-lined pits confined to the crown to deep invaginations extending through the root, occasionally communicating with periodontal or periapical tissues. The internal complexity of affected teeth presents diagnostic and therapeutic challenges, particularly in severe forms that mimic root canal systems or are associated with pulpal or periapical pathology. Maxillary lateral incisors are most frequently affected, likely due to their unique developmental timeline and morphological susceptibility. Although various classification systems have been proposed, Oehlers’ classification remains the most clinically relevant due to its simplicity and correlation with treatment complexity. Recent advances in diagnostic imaging, especially cone beam computed tomography (CBCT), have revolutionized the identification and classification of these anomalies. CBCT-based adaptations of Oehlers’ classification allow for the precise assessment of invagination extent and pulpal involvement, facilitating improved treatment planning. Contemporary therapeutic strategies now include calcium-silicate-based cement sealing materials, endodontic microsurgery for inaccessible anatomy, and regenerative endodontic procedures for immature teeth with necrotic pulps. Emerging developments in artificial intelligence, genetic research, and tissue engineering promise to further refine diagnostic capabilities and treatment options. Early detection remains critical to prevent complications such as pulpal necrosis or apical disease. A multidisciplinary, image-guided, and patient-centered approach is essential for optimizing clinical outcomes in cases of dens invaginatus. Full article

Background: Gingivitis and periodontitis are microbially associated diseases, with some features characteristic of pediatric age and others linked to systemic diseases. While the role of periodontal pathogenic bacteria is well recognized, the contribution of fungi and viruses, particularly Herpesviridae, remains controversial. Studies in adults have highlighted the presence of Herpesviridae, but evidence in pediatric subjects, especially systemically compromised, is limited. This systematic review aimed to assess periodontal status (e.g., health, gingivitis, periodontitis, necrotizing gingivitis, and/or periodontitis) and the subgingival and/or salivary microbial (bacterial, viral, and fungal) profile in systemically compromised pediatric (≤18 years) subjects with gingivitis and/or periodontitis compared to clinical periodontal health. Methods: The review protocol was registered on PROSPERO (CRD42024597695) and followed the PRISMA statement. Data from eight studies were descriptively analyzed and qualitatively assessed through ROBINS-I and JBI tools. Results: CMV was frequently detected, particularly in necrotizing gingivitis (19.40%). EBV was found in necrotizing gingivitis (20.69%) and periodontitis (10.34%); HSV was mainly associated with gingivitis and necrotizing gingivitis. Bacteria species in periodontitis included Porphyromonas gingivalis, Tannerella forsythia, Fusobacterium, and Campylobacter species. Candida albicans was detected in periodontitis, suggesting a fungal involvement in the disease’s pathogenesis. Although the bacterial and fungal profile was not investigated, limited viral presence was noted in subjects with healthy periodontium, indicating a stable microbiome. Conclusions: These findings underscore the dynamics of microbial interactions in the progression of periodontal disease in systemically compromised pediatric subjects. Full article

This review aimed to identify newly discovered bacteria from individuals with periodontal/peri-implant diseases and organize them into new clusters (GF-MoR complexes) to update Socransky’s complexes (1998). For methodological development, the PCC (Population, Concept, Context) strategy was used for the focus question construction: “In patients with periodontal and/or peri-implant disease, what bacteria (microorganisms) were detected through laboratory assays?” The search strategy was applied to PubMed/MEDLINE, PubMed Central, and Embase. The search key terms, combined with Boolean markers, were (1) bacteria, (2) microbiome, (3) microorganisms, (4) biofilm, (5) niche, (6) native bacteria, (7) gingivitis), (8) periodontitis, (9) peri-implant mucositis, and (10) peri-implantitis. The search was restricted to the period 1998–2024 and the English language. The bacteria groups in the oral cavity obtained/found were retrieved and included in the GF-MoR complexes, which were based on the disease/condition, presenting six groups: (1) health, (2) gingivitis, (3) peri-implant mucositis, (4) periodontitis, (5) peri-implantitis, and (6) necrotizing and molar–incisor (M-O) pattern periodontitis. The percentual found per group refers to the number of times a specific bacterium was found to be associated with a particular disease. A total of 381 articles were found: 162 articles were eligible for full-text reading (k = 0.92). Of these articles, nine were excluded with justification, and 153 were included in this review (k = 0.98). Most of the studies reported results for the health condition, periodontitis, and peri-implantitis (3 out of 6 GF-MoR clusters), limiting the number of bacteria found in the other groups. Therefore, it became essential to understand that bacterial colonization is a dynamic process, and the bacteria present in one group could also be present in others, such as those observed with the bacteria found in all groups (Porphyromonas gingivalis, Tannarela forsythia, Treponema denticola, and Aggregatibacter actinomycetemcomitans) (GF-MoR’s red triangle). The second most observed bacteria were grouped in GF-MoR’s blue triangle: Porphyromonas spp., Prevotela spp., and Treponema spp., which were present in five of the six groups. The third most detected bacteria were clustered in the grey polygon (GF-MoR’s grey polygon): Fusobacterium nucleatum, Prevotella intermedia, Campylobacter rectus, and Eikenella corrodens. These three geometric shapes had the most relevant bacteria to periodontal and peri-implant diseases. Specifically, per group, GF-MoR’s health group had 58 species; GF-MoR’s gingivitis group presented 16 bacteria; GF-MoR’s peri-implant mucositis included 17 bacteria; GF-MoR’s periodontitis group had 101 different bacteria; GF-MoR’s peri-implantitis presented 61 bacteria; and the last group was a combination of necrotizing diseases and molar–incisor (M-I) pattern periodontitis, with seven bacteria. After observing the top seven bacteria of all groups, all of them were found to be gram-negative. Groups 4 and 5 (periodontitis and peri-implantitis) presented the same top seven bacteria. For the first time in the literature, GF-MoR’s complexes were presented, gathering bacteria data according to the condition found and including more bacteria than in Socransky’s complexes. Based on this understanding, this study could drive future research into treatment options for periodontal and peri-implant diseases, guiding future studies and collaborations to prevent and worsen systemic conditions. Moreover, it permits the debate about the evolution of bacterial clusters. Full article

Primary root canal infection is a dynamic process. All species of oral microbiota have comparable abilities to establish in the root canals of necrotic teeth. The essential ecological factors in their biological selection are nutrient availability, anaerobic environment and bacterial interactions. In chronic apical periodontitis, all selected microflora residing in the long-term infected habitat of root canals system are synergistic, and each of them can play the role of an endodontic pathogen. Microorganisms living in the root canal system of pulpless teeth progressively reach through anatomical communications to the periodontal ligament where, sooner or later, they cause the inflammatory and immunological conflict between the infection and the host. The insight into the complexity of the root canal microbiota is improved by the current pyrosequencing and next-generation sequencing diagnostic techniques, which allow the identification of multispecies of the microbiome and their targeted treatment. The insight into the complexity of root canal microbiota is improved by present diagnostic techniques of pyrosequencing and next generation sequencing, which allow the identification of multispecies of the microbiome and their targeted treatment. Full article

The aim of the study was to collect data about the prevalence and risk factors of apical periodontitis in a population of endodontically treated patients. The study group included 151 patients (52 males, 99 females; mean age 48.36 ± 15.708 yrs.) with 391 endodontically treated teeth (mean follow-up of 5.25 ± 1.759 yrs.). According to the initial tooth diagnosis, root-filled teeth were divided into Group A, root-filled teeth treated for pulpitis or for the purpose of prosthetic pulpectomies (vital pulp group), and Group B, root-filled teeth with non-vital pulp (necrotic pulp). Clinical and radiographic evaluation of the root and its periapical area were performed to establish the success/failure of endodontic therapy, the quality of the root canal fillings (length, density, taper), and coronal restoration. The presence of recurrent caries, periodontal pathology, or endo-periodontal lesions were also recorded. Univariate and multivariate analyses were used to determine the risk factors for apical periodontitis and calculate their odds ratios (ORs). For the root-filled vital pulp tooth group, the highest risks for apical periodontitis are associated with inadequate homogeneity (OR 30.938), periodontitis (OR 9.226), and over-filling (OR 8.800). For the root-filled non-vital pulp tooth group, the highest risks are associated with periodontitis (OR 4.235) and age over 60 yrs. (OR 4.875). For the necrotic pulp tooth group, multivariate analysis identified an age > 60 yrs., filled molars, intracanal posts, poor coronal restoration quality, under-filling, and periodontitis as significant combined risk factors. Inadequate root canal filling and periodontitis in both groups were risk factors associated with most cases of apical periodontitis. Other risk factors include age > 60 yrs., poor coronal restoration quality, and the presence of intracanal posts in root-filled teeth with necrotic pulp. Full article

Necrotizing gingivitis (NG) is an acute inflammatory process with an estimated prevalence of less than 1%. The treatment of choice is usually antibiotics in addition to periodontal treatment. This scoping review aims to detail extent and type of proof related to NG in paediatric patient; moreover, a decision tree protocol was developed to define NG management in paediatric patients based on the presence or absence of systemic compromission. In addition, we also propose the use of ozone treatment as an adjuvant therapy. Seven papers (3 case reports, 2 guidelines, and 2 reviews) were selected for evaluation by reading the full texts. This review outlines the lack of research on the treatment of NG in paediatric patients; we, however, demonstrate the efficacy of the decision tree protocol by describing two case reports in which patients were treated with antibiotics according to the presence or absence of systemic involvement through the implementation of an individualized therapeutic approach, with periodontal ozone therapy. Moreover, the supportive use of this molecule in the management of NG can be a valuable tool in the healing of gingival tissues. Full article

Apical periodontitis is an inflammatory disease triggered by oral pathogens invading necrotic root canals. The aim of this study was to evaluate the coronal and root canal bacterial community profiles in primary endodontic infections with different periapical (PAI) indices in comparison to oral mucosa controls. A total of 31 patients with primary apical periodontitis, 14 with PAI-1 and 17 with PAI-3 were recruited. Microbial specimens from mucosa (control samples) and endodontic necrotic tissues were collected in each patient. Microbiota composition was studied through 16S ribosomal RNA gene amplicon sequencing analysis. Overall, 2953 taxa from 168 different genera of 451 various microbial species were retrieved in the controls and PAI-1 and PAI-3 groups. Firmicutes is the predominant phylum in the oral controls (34.5%) and PAI-1 (44.4%) groups, while Bacteroidetes is predominant in PAI-3 (38.6%). The Proteobacteria (21.5%) and Fusobacteria (12.5%) relative abundance is higher in oral controls while that of Synergistetes is higher in the PAI-1 (3.5%) and PAI-3 (2.5%) groups, being almost absent in controls (less than 0.1%). Most of the increased bacterial species found in the PAI groups were strict anaerobes. A diminished microbial diversity was found in apical periodontitis with higher PAI. These samples were also characterized by an increase in bacteria belonging to phyla and genera with an increased anaerobic character. Full article

The liver plays a vital role in the defense against infections. Porphyromonas gingivalis (P. gingivalis), a dominant etiologic oral bacterium implicated in periodontal disease (PD), has been associated with various systemic diseases. This study aimed to investigate the influence of P. gingivalis on alcohol-associated liver diseases (ALD). Mice were fed a Lieber–DeCarli liquid diet containing 5% ethanol for 10 days after an initial adaptation period on a diet with lower ethanol content for 7 days. Two days before tissue sample collection, the mice were administered P. gingivalis strain W83 (Pg) through intraperitoneal injection (IP). Pair-fed mice with Pg infection (PF+Pg) exhibited an activated immune response to combat infections. However, alcohol-fed mice with Pg infection (AF+Pg) showed liver injury with noticeable abscess lesions and elevated serum alanine aminotransferase (ALT) levels. Additionally, these mice displayed liver infiltration of inflammatory monocytes and significant downregulation of proinflammatory cytokine gene expression levels; and AF+Pg mice also demonstrated increased intrahepatic neutrophil infiltration, as confirmed by chloroacetate esterase (CAE) staining, along with elevated gene expression levels of neutrophil cytosol factor 1 (Ncf1), neutrophilic inflammation driver lipocalin 2 (Lcn2), and complement component C5a receptor 1 (C5ar1), which are associated with neutrophilic inflammation. Interestingly, compared to PF+Pg mice, the livers of AF+Pg mice exhibited downregulation of gene expression levels of NADPH oxidase 2 (Cybb), the leukocyte adhesion molecule Cd18, and the Toll-like receptor adaptor Myd88. Consequently, impaired clearance of P. gingivalis and other bacteria in the liver, increased susceptibility to infections, and inflammation-associated hepatic necrotic cell death were observed in AF+Pg mice, which is likely to have facilitated immune cell infiltration and contributed to liver injury. Furthermore, in addition to the Srebf1/Fasn pathway induced by alcohol feeding, Pg infection also activated carbohydrate response element-binding protein (ChREBP) in AF+Pg mice. In summary, this study demonstrates that P. gingivalis infection, acting as a “second hit”, induces dysfunction of immune response and impairs the clearance of bacteria and infections in alcohol-sensitized livers. This process drives the development of liver injury. Full article

The aim of this study was to clinically and radiographically assess the effects of two bioceramic cements as coronal plug materials for the revascularization of non-vital, immature, permanent teeth with apical periodontitis. Twenty non-vital, immature, permanent, anterior teeth with apical periodontitis were included in this study. Samples were randomly divided into two groups based on the coronal plug materials used; group I (GI): Well Root PT (Vericom, Gangwon-do, Korea) and group II (GII): MTA Biorep (Itena Clinical, Paris, France) (n = 10). Follow-up was conducted clinically and radiographically for up to 12 months to evaluate the changes in root dimensions and resolution of the periapical disease and investigate the degree of success. Data were statistically analyzed using ANOVA tests and Mann–Whitney U tests at a 0.05 significance level. At 12 months, none of the patients in either test group had clinical signs/symptoms. There was a slight increase in root length (4.4% in GI and 3.4% in GII) and a slight increase in dentin wall thickness (10.2% in GI and 9.9% in GII) with no statistically significant (p > 0.05) differences. Whilst there was a significant decrease in lesion dimension in all patients after 12 moths of treatment (93% in GI and 91% in GII), there were no statistically significant differences between the two study groups (p > 0.05). Regarding the degree of success, all cases (100%) achieved the primary goal (the elimination of symptoms and the evidence of bony healing), while 60% in GI and 40% in GII achieved the secondary goal (increased root wall thickness and/or increased root length). No statistically significant difference was found between groups (p > 0.05). Both bioceramic cements showed satisfactory clinical and radiographic findings. Premixed calcium aluminosilicate and tricalcium silicate cements could be used as coronal plug materials in revascularization procedures. Bioceramic cements can be considered promising coronal plug materials for the revascularization of immature, permanent teeth with necrotic pulps and apical periodontitis due to their physicochemical and biological properties. Full article

Among oral microbiota methanogens, Methanobrevibacter massiliense (M. massiliense) has remained less studied than the well-characterised and cultivated methanogens Methanobrevibacter oralis and Methanobrevibacter smithii. M. massiliense has been associated with different oral pathologies and was co-isolated with the Synergistetes bacterium Pyramidobacter piscolens (P. piscolens) in one case of severe periodontitis. Here, reporting on two additional necrotic pulp cases yielded the opportunity to characterise two co-cultivated M. massiliense isolates, both with P. piscolens, as non-motile, 1–2-µm-long and 0.6–0.8-µm-wide Gram-positive coccobacilli which were autofluorescent at 420 nm. The two whole genome sequences featured a 31.3% GC content, gapless 1,834,388-base-pair chromosome exhibiting an 85.9% coding ratio, encoding a formate dehydrogenase promoting M. massiliense growth without hydrogen in GG medium. These data pave the way to understanding a symbiotic, transkingdom association with P. piscolens and its role in oral pathologies. Full article

Periodontal disease is that condition resulting in the destruction of periodontal tissues, bone resorption, and tooth loss, the etiology of which is linked to immunological and microbiological factors. The aim of this study was to evaluate the potential trigger of periodontal disease in a rat model using bacterial species incriminated in the pathology of human periodontitis and to establish their optimal concentrations capable of reproducing the disease, with the idea of subsequently developing innovative treatments for the condition. In this study, we included 15 male Wistar rats, aged 20 weeks, which we divided into three groups. In each group, we applied ligatures with gingival retraction wire on the maxillary incisors. The ligature and the gingival sac were contaminated by oral gavage with a mixture of fresh cultures of Aggregatibacter actinomycetemcomitans (A.a), Fusobacterium nucleatum (F.n) and Streptococcus oralis (S.o) in concentrations of 10⁸, 10⁹, and 10¹⁰ CFU/mL each for 5 days a week for 4 weeks. During the clinical monitoring period of 28 days, overlapped with the period of oral contamination, we followed the expression of clinical signs specific to periodontitis. We also monitored the evolution of body weight and took weekly samples from the oral cavity for the microbiological identification of the tested bacteria and blood samples for hematological examination. At the end of the study, the animals were euthanized, and the ligated incisors were taken for histopathological analysis. The characteristic symptomatology of periodontal disease was expressed from the first week of the study and was maintained until the end, and we were able to identify the bacteria during each examination. Hematologically, the number of neutrophils decreased dramatically (p < 0.0001) in the case of the 10⁹ group, unlike the other groups, as did the number of lymphocytes. Histopathologically, we identified neutrophilic infiltrate in all groups, as well as the presence of coccobacilli, periodontal tissue hyperplasia, and periodontal lysis. In the 10⁹ group, we also observed pulpal tissue with necrotic bone fragments and pyogranulomatous inflammatory reaction. By corroborating the data, we can conclude that for the development of periodontal disease using A.a, F.n, and S.o, a concentration of 10⁹ or 10¹⁰ CFU/mL is required, which must necessarily contaminate a ligature thread applied to the level of the rat’s dental pack. Full article

Medication-related osteonecrosis of the jaw (MRONJ) is a major complication of bisphosphonate treatment in cancer patients, and its etiology is not completely clarified. The study’s goal is to find connections between the clinical and histopathological characteristics of osteonecrosis and bisphosphonates in a cohort of cancer patients who had osteonecrosis treated surgically. The retrospective study includes 51 patients of both sexes, aged 46 to 85 years, who underwent surgical treatment for MRONJ in two oral and maxillofacial surgery clinics (Craiova and Constanța). Demographic, clinical, and imaging data from the records of patients with osteonecrosis were analyzed. The surgical treatment removed the necrotic bone, and the harvested fragments were analyzed from a histopathological perspective. The histopathological examination data were evaluated and statistically processed to look for viable bone, granulation tissue, bacterial colonies, and inflammatory infiltrate. In the study groups, MRONJ was found particularly in the posterior regions of the mandible. Tooth extraction, but also periapical or periodontal infections, represented the trigger factors in most of the cases. The surgical therapy consisted of sequestrectomy or bone resection, and the histopathological examination of the fragments revealed osteonecrosis-specific features, such as the lack of bone cells, the development of an inflammatory infiltrate, and the existence of bacterial colonies. MRONJ in cancer patients receiving zoledronic acid is a severe complication that significantly lowers quality of life. Since these patients are not usually monitored by the dentist, they are identified in advanced stages of MRONJ. For these patients, thorough dental monitoring could reduce the incidence of osteonecrosis and its related complications. Full article

This study aimed to investigate the knowledge and practices among dental practitioners in Saudi Arabia regarding the use of antimicrobials for periodontal diseases. An online questionnaire was sent to senior dental students and dental practitioners including interns, general dental practitioners (GDP), and periodontists in Saudi Arabia. Two hundred and twenty-three dental practitioners responded and participated in the study. The potential associations between the use of antimicrobials and different variables were assessed by a chi-square test. The majority of the participants (84.3%) reported prescribing systemic antimicrobials for a periodontal abscess or acute necrotizing periodontal disease. Surprisingly, 31% of participants reported prescribing systemic antimicrobials for deep localized periodontal pockets or for acute gingivitis associated with herpes simplex in children. Noteworthy is that 66% of the participants thought that mechanical periodontal treatment alone, without adjunctive antimicrobial therapy, is adequate to resolve the clinical condition in most cases of periodontal diseases. Almost half of the participants recommended the use of local antimicrobials for a periodontal pocket (45.3%), a recurrent periodontal pocket (45.4%), and refractory periodontitis (43.7%). The barriers against the use of local antimicrobials were a lack of knowledge and a lack of continuous education after graduation, as reported by 64% of the participants. In conclusion, knowledge and practices regarding antimicrobial use for periodontal diseases were inadequate, especially among practitioners other than periodontists. Full article

Background: One of the main reasons for post endodontic pain is the polymicrobial intracanal flora that may survive the initial disinfection. A single antimicrobial agent might not provide adequate disinfection, and an antimicrobial combination such as triple antibiotic paste was tested to achieve this goal. Aim: The study aimed to assess the efficacy of three intra-canal medicaments on post root canal preparation pain. Materials and Methods: Eighty patients with single-rooted necrotic teeth and symptomatic apical periodontitis were randomly assigned to four treatment groups (n = 20). Their preoperative pain was recorded on Wong-Baker’s FACES pain rating scale. After chemo-mechanical canal preparation, intracanal medications were applied to the groups (Group 1 (20% calcium hydroxide), Group 2 (2% chlorhexidine), Group 3 (tri-antibiotic paste), Group 4 (no medication (Control group)). Patients were instructed to record pain on the Wong-Baker FACES pain rating scale at 4, 48, 72 and 96 hrs, postoperatively. Pain scores were analyzed using a one-way ANOVA test and Tukey’s post hoc test and, if significant, Dunn’s test was used for pair-wise comparisons. The significance level was set at a p-value ≤ 0.05. Results: Tukey’s post hoc test revealed significantly lower pain scores in Group 3 compared with other groups at all follow up intervals. Dunnett’s test showed significantly lower pain in Group 3 compared with the Control group at 48, 72 and 96 hrs, postoperatively. Conclusions: Triple-antibiotic paste showed effective pain control as an intracanal medication on necrotic teeth with symptomatic apical periodontitis. Full article