Search Results (180)

Background/Objectives: This systematic review aimed to evaluate the clinical and immunological outcomes of non-surgical periodontal therapy (NSPT) in HIV-positive patients with periodontitis. Methods: Systematic search on four databases (PubMed, Scopus, Web of Science, Cochrane Library) and the gray literature was completed through December 2025. A comprehensive set of clinical parameters and immunological markers were assessed. Three studies met the inclusion criteria and were included in the final synthesis and qualitative analysis. Extracted outcomes included clinical periodontal parameters (PPD, CAL, BoP, PI, GBI, BI) and immunological markers (viral load, CD4+ lymphocyte count, CD4/CD8 ratio, salivary LF, salivary HST, GCF LF, GCF HST). Results: With a very low level of certainty, NSPT was generally associated with significant improvements in clinical periodontal parameters compared to before treatment measurements and HIV-negative individuals. Improvements in immunological status were also reported. Heterogeneity of study designs and reporting standards limited this study’s quantitative analysis. Conclusions: NSPT demonstrates beneficial clinical and immunological outcomes in people living with HIV. However, the very low level of certainty in the available data limits confidence in changes in periodontal status and immune system reconstitution following NSPT in this population; therefore, the findings remain inconclusive and should be interpreted with caution. Full article

Background: Periodontitis is a multifactorial, chronic inflammatory disease that leads to progressive destruction of the periodontal apparatus. Despite the effectiveness of scaling and root planing (SRP), residual inflammation and limited regenerative potential justify the search for adjunctive biologic therapies. Platelet-derived concentrates, including platelet-rich plasma (PRP), platelet-rich fibrin (PRF), concentrated growth factors (CGF), and platelet-poor plasma (PPP), have gained attention as autologous sources of growth factors enhancing periodontal regeneration. Aim: This narrative review provides a comparative analysis of the biological mechanisms, preparation protocols, and clinical outcomes associated with the adjunctive use of platelet-derived concentrates in non-surgical periodontal therapy. Methods: A narrative literature review was conducted using English-language publications retrieved from PubMed and Google Scholar, covering studies published from 2012 onward. The search strategy was based on combinations of keywords related to platelet-derived concentrates and non-surgical periodontal therapy. In vitro, in vivo, and clinical studies, as well as relevant narrative, systematic, and umbrella reviews evaluating the adjunctive use of platelet-derived concentrates (PRP, PRF, CGF, and PPP) were considered. Studies focusing on biological mechanisms, preparation protocols, and clinical periodontal outcomes were included, whereas case reports, studies unrelated to periodontal therapy, and publications lacking relevant clinical or biological outcome data were excluded. Results: Most clinical studies reported improvements in probing depth reduction, clinical attachment level gain, and bleeding indices following adjunctive use of platelet-derived concentrates with SRP. PRF tended to demonstrate more consistent clinical outcomes compared to PRP, potentially related to its simplified preparation and sustained release of bioactive molecules. CGF showed promising osteogenic and angiogenic properties in preclinical and early clinical studies. PPP, although less extensively investigated, exhibited regenerative and antimicrobial potential in preliminary reports. Conclusions: Platelet-derived concentrates may serve as valuable adjuncts in non-surgical periodontal therapy; however, the current evidence is characterized by methodological heterogeneity and variable study quality. While PRF appears to yield more consistent clinical results, definitive conclusions regarding superiority among different platelet concentrates cannot be drawn. Further well-designed randomized controlled trials are required, particularly for CGF and PPP. Full article

Background/Objectives: Periodontal disease is a prevalent chronic inflammatory condition that often progresses to irreversible tissue destruction. This study aimed to evaluate the clinical efficacy of a combined minimally invasive periodontal therapeutic protocol scaling and root planing (SRP) with injectable platelet-rich fibrin (i-PRF) and microneedling (MN) compared to conventional SRP with i-PRF alone in patients with stage II–III periodontitis. Methods: A prospective split-mouth clinical study was conducted on 54 patients diagnosed according to the 2018 EFP/AAP classification. Each participant received SRP + i-PRF in the upper arch (control) and SRP + i-PRF + MN in the lower arch (test). Periodontal parameters clinical attachment level (CAL), bleeding on probing (BOP), and plaque index (PI) were measured at baseline, 1, 3, and 6 months. Data were analyzed using Friedman and Wilcoxon tests with Bonferroni correction. Results: Both treatment protocols produced significant longitudinal improvements in CAL, BOP, and PI (p < 0.001). The most pronounced BOP reduction occurred within the first month, while CAL improvement was progressive and stabilized after six months. The Combined protocol achieved slightly greater CAL gain at 6 months (mean difference ≈ 0.46 mm; p = 0.0013), indicating a modest yet statistically significant advantage in attachment recovery. Correlation analyses confirmed a coherent healing trajectory characterized by early inflammation resolution, plaque control, and later tissue stabilization. Conclusions: Both i-PRF-based regenerative approaches significantly improved periodontal parameters. The addition of MN enhanced CAL recovery and may favor early vascularization and collagen remodeling. Although the clinical difference was limited, the biological plausibility and sustained improvement suggest that MN could represent a valuable adjunct to non-surgical regenerative periodontal therapy. Longer-term studies are warranted to assess the durability of these effects. Full article

Due to the limitations of SRP, new methods are being sought to support non-surgical periodontal therapy. One of them is the use of antiseptics such as low-concentration sodium hypochlorite gel buffered with amino acids (NaOCl/AA). The aim of the study was to evaluate periodontal parameters and the concentration of metalloproteinase 8 (MMP-8) and interleukin 8 (IL-8) in the gingival crevicular fluid (GCF) after SRP with or without NaOCL/AA gel. The study included 40 periodontal patients randomized to study and control groups. Before SRP, the study group had a gel introduced into pockets with PD ≥ 5 mm. After treatment in both groups, the pocket depth (PD) decreased, there was a CAL gain, and unnoticeable changes in the gingival recession (GR). In the study group, deep pockets accounted for 25% of the sites examined prior to therapy, whereas after therapy, they decreased to 12%. In the control group, the proportion of deep periodontal pockets (PD ≥ 5 mm) fell from 17.46% to 9.05%. No differences were noted between groups. In the study group, there was a significant reduction in the amount of MMP-8 in GCF from 8.32 ng/mL to 5.14 ng/mL after 3 months. No statistically significant difference was observed in the control group. The concentration of IL-8 decreased significantly over time in both groups without differences between them. A single application of the NaOCl/AA gel in deep periodontal pockets does not affect clinical results and IL-8 levels. However, it had a significant effect on the amount of MMP-8. Full article

Background/Objectives: Scaling is central to non-surgical periodontal therapy; however, it is often perceived as uncomfortable, particularly in periodontitis. Psychological distress may amplify pain and reduce adherence. This comparative pilot study assessed whether ultrasonic technology influences patient-reported pain and psychoemotional status while quantifying the contribution of the periodontal condition and baseline psychological factors. Methods: A monocentric split-mouth design enrolled 42 adults (21 with stage I–III, grade B periodontitis; 21 periodontally healthy). Maxillary scaling was performed with Device nr.1 and mandibular scaling was performed with Device nr.2, and no anesthesia was used. Pain was measured immediately post-procedure using the Short-Form McGill Pain Questionnaire (SF-MPQ; sensory and affective subscales). Psychological status was assessed pre- and post-session with the Kessler Psychological Distress Scale (K10) and the Rosenberg Self-Esteem Scale (RSES). Construct validity was examined via exploratory factor analysis. The Mann–Whitney U, Wilcoxon signed-rank, Spearman’s ρ, and Cliff’s δ were applied (α = 0.05). Results: The overall pain was low. Between devices, sensory pain did not differ, whereas affective pain was modestly lower with the “No Pain” device (p = 0.017). Periodontitis was the dominant determinant of pain: higher sensory (U = 509.00, p = 0.0004; δ = 0.42) and affective scores (U = 290.00, p < 0.0001; δ = 0.67) occurred irrespective of device, while device-related effects were negligible (sensory δ = −0.03) to small (affective δ = 0.27). Somatic distress correlated with affective pain (ρ = 0.25, p = 0.023) and was borderline for sensory pain (ρ = 0.21, p = 0.060); emotional distress showed no significant associations. During the session, K10 scores decreased and RSES values increased, indicating immediate psychoemotional benefits. Conclusions: Pain perception during scaling is shaped primarily by periodontal status and psychological distress rather than by ultrasonic technology per se. Although the electronic module to dynamically adjust the power of the instrument technology may attenuate the affective component, standardized atraumatic techniques and routine psychosocial screening are likely to yield greater gains. The observed short-term improvements in distress and self-esteem support integrating patient-reported outcomes into individualized, patient-centered periodontal care. Full article

Background: Periodontitis is associated with systemic inflammation; however, the relationship between disease severity and systemic inflammatory biomarkers remains unclear. This study aimed to evaluate the association between periodontitis stage and grade with systemic levels of C-reactive protein (CRP), interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) and assess changes following standardized non-surgical periodontal therapy. Methods: Patient records from the University Dentistry Clinical Center of Kosovo were reviewed. Periodontitis was classified using the 2018 staging and grading system. Periodontal parameters (probing pocket depth, clinical attachment loss, bleeding on probing, plaque index, and gingival index) were assessed at six sites per tooth (excluding third molars). Serum levels of IL-1β, IL-6, TNF-α, and high-sensitivity CRP were measured before and after therapy using high-sensitivity ELISA. Blood samples were centrifuged, and serum was stored at −20 °C. All patients underwent standardized non-surgical periodontal therapy, including full-mouth scaling and root planning, without systemic antibiotics. Data were analyzed using SPSS v22.0. Results: Among the patients, 28.0% had Stage I–II, 40.0% Stage III, and 32.0% Stage IV periodontitis; 29.3% were Grade A, 45.3% Grade B, and 25.3% Grade C. At baseline, all systemic inflammatory biomarkers (CRP, IL-1β, IL-6, and TNF-α) were significantly higher in periodontitis patients compared with the control group, indicating an increased systemic inflammatory burden before therapy. After therapy, significant reductions in CRP, IL-1β, IL-6, and TNF-α were observed across all stages and grades (all p < 0.01), indicating a decrease in systemic inflammatory burden. Conclusions: Non-surgical periodontal therapy significantly lowers systemic inflammatory biomarkers regardless of periodontitis severity, supporting their role as indicators of disease activity and treatment response. Full article

Background and Clinical Significance: Advanced periodontitis with severe vertical bone loss and grade III mobility is usually managed by extraction and implant placement. Digital workflows and modern regenerative techniques have opened the possibility of preserving teeth that would traditionally be considered for extraction. This report describes a digitally guided modified intentional replantation (MIR) protocol applied to a maxillary tooth with severe periodontal involvement and unfavourable prognosis. Case Presentation: A 68-year-old male, non-smoker, with a history of heart transplantation under stable medical control, presented with generalized Stage IV, Grade C periodontitis. Tooth 21 showed >75% vertical bone loss, probing depths ≥ 9 mm, bleeding on probing, and grade III mobility. After non-surgical therapy and periodontal stabilization, a CAD/CAM-assisted MIR procedure was planned. Cone-beam computed tomography (CBCT) and a 3D-printed tooth replica were used to design a surgical guide for a new recipient socket. The tooth was atraumatically extracted, stored in chilled sterile saline, and managed extraorally for approximately 10 min. Apicoectomy and retrograde sealing with Biodentine^® were performed, followed by immediate replantation into the digitally prepared socket, semi-rigid splinting, and guided tissue regeneration using autologous bone chips, xenograft (Bio-Oss^®), enamel matrix derivative (Emdogain^®), and a collagen membrane (Bio-Gide^®). A conventional orthograde root canal treatment was completed within the first month. At 12 months, tooth 21 exhibited grade 0 mobility, probing depths of 3–4 mm without bleeding on probing, and stable soft tissues. Standardized periapical radiographs and CBCT showed radiographic bone fill within the previous defect and a continuous periodontal ligament-like space, with no signs of ankylosis or root resorption. The tooth was fully functional and asymptomatic. Conclusions: In this medically complex patient, digitally guided MIR allowed preservation of a tooth with severe periodontal involvement and poor prognosis, achieving favourable short-term clinical and radiographic outcomes. While long-term data and larger series are needed, MIR may be considered a tooth-preserving option in carefully selected cases as an alternative to immediate extraction and implant placement. Full article

Objective: We aimed to synthesize paired pre/post human evidence on how Th17-axis cytokines (IL-17A, IL-21, IL-22, IL-23 and related markers) change after non-surgical periodontal therapy (NSPT) by biospecimen (gingival crevicular fluid [GCF], saliva, serum) and time window. Material and methods: We performed a PRISMA-guided systematic review of non-randomized pre/post cohorts and clinical trials. Databases (PubMed, Embase, Scopus, Cochrane) were searched; two reviewers performed selection, data extraction, ROBINS-I risk-of-bias appraisal, and GRADE certainty assessment. Due to heterogeneity in sampling/assays and incomplete variance reporting, a qualitative direction-of-effect synthesis was prespecified for ≤4 weeks, ~6–8 weeks, and ~3–6 months. Results: Twelve studies (total n = 897) met inclusion (8 GCF; 5 blood-derived (serum/plasma) cohorts; one saliva). Most GCF cohorts reported decreases in IL-17A within ~6–8 weeks post-NSPT (≥4 cohorts), with one early 4-week cohort showing a concentration increase but an unchanged total amount due to reduced GCF volume. IL-23 generally declined locally and declined by ~3 months systemically in aggressive periodontitis. Serum IL-17A changes were smaller/variable (two cohorts reported decreases within 1–6 months), and one cohort showed a reduced IL-17A:IL-17E ratio at ~25 weeks. Heterogeneity precluded meta-analysis; we undertook a direction-of-effect synthesis. Conclusions: NSPT is likely associated with the early local down-regulation of Th17-axis activity (notably GCF IL-17A), when systemic signals are smaller and delayed. Given moderate–serious risk of bias and pre-analytical heterogeneity, the certainty of evidence is low to very low; Th17-axis biomarkers are not yet suitable for clinical decision-making. Full article

Background: This randomized clinical trial compared the effects of topical irrigation with a desiccant agent (HybenX Oral Tissue Decontaminant, HBX) combined with full-mouth ultrasonic debridement as well as scaling and root planing (FMUD-SRP) versus conventional non-surgical periodontal therapy (US-SRP). Methods: Three quadrants per patient with probing pocket depth (PPD) ≥ 5 mm were randomly assigned to (i) the control group (US-SRP only), (ii) test group 1 (HBX + US-SRP at baseline, HBX 1T (one time)), or (ii) test group 2 (HBX + US-SRP across three sessions, HBX 3T (three times)). Clinical parameters included probing pocket depth (PPD), bleeding on probing (BOP), plaque index (PI), gingival recession (REC), and Clinical Attachment Level (CAL), recorded at baseline (Tbase), 45 days (T45d), and 90 days (T90d). Microbiological sampling was conducted for all sites at Tbase, T45d, and T90d to assess periodontal pathogens. HBX-treated sites received gel application for 60 s, followed by a saline rinse and US-SRP. Results: Significant differences were found between groups in PPD (p = 0.04) and CAL (p = 0.02) at T45d versus Tbase, while BOP, PI, and REC showed no significant inter-group differences at T45d. The HBX 3T group demonstrated greater pathogen reduction compared to the control and HBX 1T groups, except for one bacterial species. Conclusions: All treatments improved clinical and microbiological parameters. Even if single and triple applications of HBX showed similar clinical results, the repeated application achieved greater bacterial reduction. Full article

The increased incidence of periodontitis, the resistance of periodontal pathogens to antibiotics, and the adverse effects of certain drugs used in general dentistry present a strong rationale for seeking safe and effective plant-based treatments for periodontitis. HPLC-DAD analysis of a commercial herbal tincture confirmed the presence of rosmarinic acid (1102.79 ± 21.56 µg/mL), luteolin-7-O-glucoside (358.06 ± 5.64 µg/mL), and isorhamnetin (24.17 ± 0.49 µg/mL), bioactive phytochemicals known for their antimicrobial and anti-inflammatoryproperties. The randomized prospective study analyzed Tinctura paradentoica^® as an adjunct to anti-infectious non-surgical periodontal therapy (NSPT) on clinical and microbiological parameters in patients with moderate periodontitis (Stage II, Grade A). All 60 recruited participants were randomly allocated to either the intervention group (NSPT + Tinctura paradentoica^®) or the control group (NSPT alone). The rate of prevalence of the following periodontopathogenic microorganisms (Treponema denticola, Tannerella forsythensis), assessed by polymerase chain reaction (PCR) analysis, was significantly lower in the intervention group (p < 0.001), but no statistically significant difference was found for Porphyromonas gingivalis. The herbal tincture, combined with NSPT, produces a short-term reduction in periodontal clinical parameters (Green–Vermilion plaque index, bleeding on probing index (BOP), and clinical attachment level (CAL), without clinical relevance, and the prevalence of the following bacteria species (Tannerella forsythensis, Treponema denticola). Full article

Periodontitis is one of the most common inflammatory diseases and it is linked to the presence of a dysbiotic subgingival microbiome. The purpose of this review is to evaluate the impact of antimicrobial photodynamic therapy (aPDT) on the subgingival microbiome. Herein, based on an extensive evaluation of randomized controlled trials (RCTs), the effects of aPDT as a supplement to non-surgical periodontal therapy (NSPT) were found to be the main focus of these works. Studies that focused on analyzing microbiological results were selected, yielding contradictory results. The observed microbiological changes were variable, even though some studies showed notable improvements in clinical indicators such as bleeding on probing (BOP), clinical attachment level (CAL), and probing depth (PD). Several studies found that aPDT did not significantly reduce important periodontal pathogens such Tannerella forsythia, Porphyromonas gingivalis, and Aggregatibacter actinomycetemcomitans. Nevertheless, after multiple aPDT sessions, other studies reported positive changes in the subgingival microbiome, with a rise in beneficial bacteria and a decrease in periodontopathogens. While aPDT seems to be a safe and well-tolerated adjuvant to non-surgical periodontal therapy, there is still conflicting evidence regarding how well it modulates the subgingival microbiota. Additional long-term research with larger sample sizes is required to evaluate the microbiological and clinical advantages of aPDT. Full article

Periodontitis is a prevalent chronic inflammatory disease with complex etiopathogenesis involving microbial dysbiosis, host immune response, environmental factors, and genetic susceptibility. Among the cytokines implicated in periodontal immunoregulation, interleukin-35 (IL-35) has emerged as a novel anti-inflammatory mediator with potential diagnostic and therapeutic relevance. This narrative review evaluates the role of IL-35 in periodontal disease by exploring its local and systemic expression, response to non-surgical periodontal therapy (NSPT), and association with clinical disease severity. Additionally, current evidence regarding IL-35 gene polymorphisms and their potential contribution to individual susceptibility and disease progression, as well as their relevance in related systemic conditions, is assessed. A comprehensive review and synthesis of recent clinical and experimental studies were conducted, focusing on IL-35 levels in saliva, serum, and gingival crevicular fluid (GCF) among patients with healthy periodontium, gingivitis, and various stages of periodontitis, both before and after NSPT. Emphasis was placed on longitudinal studies evaluating IL-35 dynamics in correlation with periodontal parameters, as well as genetic association studies investigating IL-12A and EBI3 gene polymorphisms. IL-35 levels were generally found to be higher in healthy individuals and reduced in periodontitis patients, indicating a possible protective role in maintaining periodontal homeostasis. Following NSPT, IL-35 levels significantly increased, corresponding with clinical improvement and reduced inflammatory burden. Genetic studies revealed variable associations between IL-35 polymorphisms and susceptibility to periodontitis and related systemic conditions, although further research is needed for validation. IL-35 appears to function as a modulator of immune resolution in periodontal disease, with potential utility as a non-invasive biomarker for disease activity and therapeutic response. Its upregulation during periodontal healing supports its role in promoting tissue stabilization. The integration of cytokine profiling and genetic screening may enhance personalized risk assessment and targeted interventions in periodontal care. Full article