Search Results (104)

Background/Objectives: To evaluate the clinical and microbiological effects of adjunctive gaseous ozone therapy combined with full-mouth ultrasonic debridement and scaling and root planing (FMUD–SRP) in patients with generalized periodontitis. Materials and Methods: Thirty-nine patients with stage II–IV generalized periodontitis were enrolled in a randomized split-mouth clinical trial. Quadrants were assigned to receive FMUD–SRP alone or FMUD–SRP plus adjunctive gaseous ozone therapy. Ozone (2100 ppm, 80% oxygen) was applied subgingivally immediately after instrumentation during three treatment sessions. Clinical parameters were recorded at baseline, 45, and 90 days. Subgingival plaque samples were analyzed using qualitative polymerase chain reaction to detect six periodontal pathogens. Results: Both treatments resulted in significant clinical improvements over time (p < 0.05). At 90 days, ozone-treated sites showed greater probing pocket depth reduction (−1.6 ± 0.8 mm vs. −1.2 ± 0.8 mm; p = 0.02) and clinical attachment level gain (−1.1 ± 1.0 mm vs. −0.6 ± 1.0 mm; p = 0.03) compared with control sites. No significant intergroup differences were observed for bleeding on probing, plaque index, or gingival recession. A significantly greater reduction in the detection frequency of periodontal pathogens was observed in the ozone group, including complete suppression of Treponema denticola and marked reductions in other anaerobic species. Conclusions: Adjunctive gaseous ozone therapy enhances the clinical outcomes of non-surgical periodontal treatment and exerts a selective antimicrobial effect against anaerobic periodontal pathogens. Full article

Objective: To report the conservative management of a complex failed apexification in a permanent premolar complicated by severe internal root resorption, irregular apical calcification, and exceptionally thin root canal walls and to evaluate its long-term (56-month) clinical and radiographic outcomes. Methods: A 27-year-old male presented with chronic apical periodontitis in the right mandibular first premolar. A previous apexification attempt had failed, resulting in arrested root development, an apical calcified bridge, and extensive internal root resorption. CBCT imaging revealed a critical root canal wall thickness of less than 1 mm in the middle and coronal thirds. To avoid extraction or invasive surgery, a non-surgical apical barrier technique was performed. Due to the severe structural compromise and high risk of root fracture, mechanical instrumentation was minimized; instead, chemomechanical debridement was optimized using Er:YAG laser-activated irrigation. The apical region was sealed with a bioceramic material (iRoot BP), and the weakened root structure was reinforced intraradicularly with dual-cure flowable resin, followed by progressive occlusal adjustments. Results: At the 3-month follow-up, the patient was completely asymptomatic, and radiographs indicated initial periapical bone healing. The 56-month follow-up demonstrated progressive formation of mineralized tissue, apparent thickening of the root canal walls at root apex, complete resolution of periapical radiolucency, and a stable, functional occlusion. Conclusions: This case demonstrates that teeth with severe structural compromise and internal resorption following failed apexification are not necessarily hopeless. A tailored conservative approach, integrating advanced laser-assisted disinfection, bioceramic apical barriers, internal resin reinforcement, and meticulous occlusal management, can yield highly successful long-term outcomes, ensuring the preservation of the natural dentition. Full article

Background/Objectives: Peri-implant diseases, encompassing peri-implant mucositis and peri-implantitis, affect 43% and 18.8–23% of implant-bearing patients, respectively, representing significant clinical challenges in implant dentistry. While mechanical debridement remains foundational, biologically active materials offer promising adjunctive regenerative strategies. This narrative review synthesises current evidence regarding five biologically active materials: enamel matrix derivative (EMD), platelet-rich fibrin (PRF), fibroblast growth factor-2 (FGF-2), recombinant human platelet-derived growth factor-BB (rhPDGF-BB/GEM 21S^®), and polynucleotide–hyaluronic acid combinations (Regenfast^®). Methods: The relevant literature was identified using electronic databases, including MEDLINE, PubMed, Scopus, and Google Scholar. This review focused on clinical studies and randomised controlled trials with a minimum follow-up of six months investigating biologically active materials in peri-implant disease management. Material mechanisms, clinical efficacy, therapeutic limitations, and evidence quality were systematically evaluated. Attention was directed toward identifying genuine biological distinctions between peri-implant and periodontal disease contexts. Results: EMD demonstrates efficacy exclusively within multimodal surgical protocols, with isolated application yielding limited benefits. rhPDGF-BB shows superior periodontal regenerative capacity; however, dedicated peri-implantitis trials remain absent. FGF-2 exhibits paradoxical osteogenic suppression despite bone fill achievement, limiting peri-implant applicability. PRF and Regenfast^® demonstrate a mechanistically sound rationale yet lack substantive peri-implant disease validation. The critical findings revealed that peri-implant regeneration fundamentally differs from periodontal regeneration: implants lack periodontal ligament anatomy, rendering ligamentogenic differentiation-promoting agents biologically inappropriate. Conclusions: Contemporary biologically active materials demonstrate compelling periodontal efficacy yet remain inadequately validated for peri-implantitis management. This disparity reflects authentic biological distinctions rather than insufficient investigation. Until multicentre randomised controlled trials stratify efficacy across distinct peri-implant disease presentations, practitioners must prioritise evidence-based surgical fundamentals—meticulous decontamination, strategic grafting, and optimised wound healing—integrating biologically active materials judiciously within comprehensive, anatomy-respecting treatment protocols. Full article

Background and Objectives: Halitosis is a prevalent oral concern that meaningfully affects oral health-related quality of life (OHRQoL), yet how active dental treatment is associated with short-term changes in the objective–subjective halitosis–QoL nexus remains poorly quantified. Interpretation is complicated by the multifactorial nature of malodor and by baseline differences between patients selected for different dental procedures. We compared changes in volatile sulfur compound (VSC) emissions, organoleptic ratings, tongue-coating burden, and OHIP-14 across three contrasting treatment modalities and explored whether VSC change statistically accounted for OHRQoL change. Methods: In a non-randomized prospective comparative study, 119 adults (18–67 y) commencing one of three procedures were assessed at baseline and at 8 weeks: scaling and root planing (Group A, n = 42), fixed prosthodontic rehabilitation (Group B, n = 38), or fixed orthodontic appliance bonding (Group C, n = 39). Outcomes included Halimeter^® VSC (ppb), Rosenberg organoleptic score (0–5), Winkel tongue-coating index (TCI), self-perceived halitosis, and OHIP-14 total and seven-domain scores. Mixed-design ANOVA, ANCOVA, prespecified multivariable regression, mediation (5000 bootstrap resamples), receiver operating characteristic analysis, and four-class latent class analysis were performed. A sensitivity-analysis framework including expanded covariate adjustment, propensity-score overlap weighting, and baseline-severity strata was also applied to address residual baseline imbalance. Secondary mediation, ROC, and latent-class analyses were considered exploratory. Results: At 8 weeks, VSCs fell by 116.4 ± 38.7 ppb in Group A and 35.4 ± 29.1 ppb in Group B but rose by 34.3 ± 28.6 ppb in Group C (p < 0.001). OHIP-14 improved by 10.3 and 4.9 points in A and B and worsened by 3.7 in C (p < 0.001). ΔVSC correlated with ΔOHIP-14 (ρ = 0.51, p < 0.001) and most strongly with the psychological discomfort domain (ρ = 0.58). VSC change mediated 35.1% of the periodontal-versus-orthodontic association on QoL (indirect β = −4.7; 95% CI −6.3 to −3.1). Because VSC and OHIP-14 changes were measured over the same interval, mediation was interpreted cautiously. A ΔVSC threshold of −63 ppb predicted clinically meaningful OHIP-14 improvement (AUC = 0.81). Latent class analysis identified four distinct responder phenotypes. The cutoff and responder classes were internally derived and require external validation. Sensitivity analyses preserved the direction of the primary contrasts, but residual confounding remains possible. Conclusions: Treatment modality was associated with the direction and magnitude of halitosis and QoL change, with orthodontic patients constituting a vulnerable subgroup. Targeted oral-hygiene reinforcement during fixed-appliance therapy is warranted. Full article

Periodontitis is a chronic inflammatory condition characterized by the progressive destruction of periodontal supporting tissues. With a global prevalence exceeding 60%, it poses a significant public health challenge. Traditional therapeutic approaches, primarily mechanical debridement, systemic antibiotics, and surgical interventions, often face limitations such as incomplete biofilm removal, rapid drug clearance, and systemic adverse effects. To overcome these challenges, recent research has shifted towards the development of intelligent biomaterials capable of modulating the pathological microenvironment. These microenvironment-responsive strategies leverage unique biochemical signatures, including acidic pH, elevated reactive oxygen species (ROS), and enzymatic dysregulation, to facilitate precise, on-demand drug delivery at the lesion site. This review examines recent advances from three integrated perspectives: (1) material platforms (hydrogels, microneedles, fiber membranes, microspheres, inorganic nanoparticles, and vesicles); (2) responsive design (pH, ROS, enzyme, glucose, and multi-stimulus cascade logic); and (3) spatiotemporal functional orchestration (early-stage microecological remodeling, mid-stage osteoimmunomodulation, and late-stage tissue regeneration). Additionally, we analyze critical translational challenges, including manufacturing scalability, clinical sterilization, and long-term biosafety, while discussing prospects for clinical implementation. This review aims to provide a strategic roadmap and theoretical guidance for the development of next-generation precision therapies for periodontitis. Full article

Background: The primary goal of root canal treatment is the prevention and healing of apical periodontitis through the meticulous elimination of pathogenic bacteria and infected tissues. Within this framework, apical patency remains a fundamental yet debated clinical concept. Objectives: This review aims to evaluate the clinical significance of maintaining apical patency, its influence on postoperative discomfort, and the technical strategies required for predictable negotiation. Methods: We performed a comprehensive review of existing literature, including clinical studies and recent meta-analyses, focusing on the correlation between patency maneuvers and postoperative pain, the role of preoperative CBCT imaging, and the efficacy of specialized negotiation instruments and motor kinematics. While patency facilitates thorough debridement, evidence regarding its impact on postoperative pain is conflicting, with recent meta-analyses suggesting it may actually alleviate discomfort intensity. Preoperative CBCT was identified as essential for identifying complex anatomy, such as the MB2 canal. Furthermore, the use of specialized files and reciprocating motor modes enhances the predictability of glide path establishment. Conclusions: Although failure to achieve patency does not always dictate a negative outcome, it is associated with improved long-term healing. Clinicians should prioritize “Anatomical Patency”—respecting original morphology—over forceful “Operative Patency” to ensure procedural integrity and clinical success. Full article

Background: The effectiveness of non-surgical periodontal therapy largely depends on the ability of instruments to efficiently remove plaque and calculus from root surfaces. In recent years, innovative instruments such as LM Sharp Diamond™ curettes have been introduced, featuring a coated blade that maintains sharpness without the need for resharpening. The aim of this pilot in vitro study was to compare the cleaning efficacy of LM Sharp Diamond curettes with that of conventional stainless-steel curettes, hypothesizing that the diamond-coated instruments would demonstrate superior deposit removal efficiency. Materials and Methods: Extracted teeth were selected, fixed on a support, and the root surfaces were coated with black varnish to simulate plaque and calculus deposits. Standardized photographs were taken at baseline (T0). The coated root surfaces were then instrumented using LM Sharp Diamond™ curettes (test group) or traditional Gracey curettes (control group). After treatment (T1), the images were analyzed with Image Color Summarizer software 0.82 to calculate the percentage of cleaned surface. The results were subjected to statistical analysis performed by a professional statistician. Results: The results, obtained from the treatment of nine surfaces, demonstrated that LM Sharp Diamond™ curettes achieved greater and more consistent removal efficiency, with a mean reduction of 1.27 percentage points in residual coated area (RCA) deposits compared to traditional curettes (p = 4.45 × 10⁻⁶). Conclusions: Preliminary evidence suggests that LM Sharp Diamond™ curettes may ensure more effective residue removal than traditional steel curettes. Statistically, it has been shown that LM Sharp Diamond™ curettes provide a cleaner and more uniform surface than traditional steel curettes. Full article

Periodontitis is a highly prevalent chronic inflammatory disease with significant oral and systemic consequences, including associations with cardiovascular disease, diabetes, and adverse pregnancy outcomes. Although mechanical debridement remains the cornerstone of therapy, adjunctive antibiotic use is increasingly limited by antimicrobial resistance, biofilm-associated tolerance, pharmacokinetic constraints, and disruption of the commensal microbiome, leading to inconsistent outcomes and disease recurrence. This review highlights the mechanistic limitations of conventional antibiotic therapies in periodontitis and critically examines emerging next-generation therapeutic strategies aimed at overcoming these challenges. Specifically, it explores antimicrobial peptides, quorum sensing inhibitors, nanotechnology-based drug delivery systems, host modulation approaches, and microbiome-targeted therapies, with emphasis on their molecular mechanisms, clinical relevance, and translational potential. By integrating microbial, host, and pharmacological perspectives, this review provides a comprehensive framework for advancing precision-guided periodontal therapy and supports the shift toward targeted, sustainable, and personalized treatment strategies. Full article

Background: The aim of the present narrative review is to synthesize the available scientific evidence comparing periodontal endoscopy-assisted therapy with established surgical regenerative procedures for the treatment of intrabony periodontal defects. While regenerative surgery—including papilla-preserving techniques—remains the standard approach for achieving predictable clinical attachment gain, these procedures may potentially compromise papillary integrity and healing dynamics. Periodontal endoscopy enables enhanced visualization and debridement without surgical access. This review evaluates available studies and discusses whether endoscopy-assisted therapy can achieve outcomes comparable to surgical regeneration while reducing tissue trauma and preserving interdental anatomy. Methods: A comprehensive literature search was conducted using the electronic databases PubMed, Web of Science, The Cochrane Library, and Scopus, supplemented by manual searching. The search was performed up to 1 November 2025. Results: Two studies were included. Overall, there is a substantial lack of RCTs directly comparing periodontal endoscopy-assisted therapy with surgical regenerative procedures. However, EASD (Endoscopic- assisted subgingival debridement) was found not to be inferior to papilla-preservation surgery (PPFS) for treating residual pockets in intrabony defects. Both PPFS and EASD were effective, although PPFS showed more consistent microbial modulation. Conclusions: Periodontal endoscopy-assisted therapy may be considered a promising minimally invasive approach for selected intrabony defects, potentially reducing surgical morbidity and preserving interdental tissues. Although early data suggest that endoscopy-guided approaches may offer comparable clinical improvements with less invasiveness, the evidence base is too small to support definitive recommendations. Robust, well-designed randomized trials are needed to define its clinical indications and compare it directly with established regenerative procedures. Full article

Background: Vitamin D has been increasingly investigated for its pleiotropic immunomodulatory and antimicrobial effects, which may influence periodontal inflammation and healing. This systematic review aimed to evaluate the impact of serum vitamin D levels and vitamin D supplementation as an adjunct to non-surgical periodontal therapy (NSPT) on clinical and microbiological outcomes in patients with periodontitis. Methods: An electronic search was conducted in MEDLINE and other major databases up to September 2025. Randomized controlled trials assessing the relationship between vitamin D status or supplementation and periodontal outcomes following NSPT were included. Data were synthesized qualitatively, focusing on changes in serum 25(OH)D levels and periodontal parameters, including probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and gingival inflammation. Results: Four studies met the inclusion criteria. In patients with sufficient baseline vitamin D levels, supplementation provided limited additional clinical benefits beyond NSPT alone. Conversely, in vitamin D-deficient patients, supplementation regimens capable of restoring serum 25(OH)D levels above 30 ng/mL were consistently associated with greater reductions in PPD, improved CAL, and decreased plaque and bleeding indices. Microbiological analyses also revealed a reduction in red complex periodontal pathogens in supplemented groups. Conclusions: Vitamin D supplementation enhances the clinical effectiveness of NSPT primarily in patients with documented vitamin D deficiency. Its adjunctive benefits appear to be mediated by immunomodulatory and antimicrobial mechanisms that complement mechanical debridement. While current evidence supports targeted supplementation in deficient individuals, long-term randomized trials are required to establish standardized protocols and confirm sustained clinical benefits. Full article

Background and Objectives: The use of St. John’s wort (Hypericum perforatum) in periodontal therapy remains underexplored despite its anti-inflammatory, antimicrobial, and potential osteoregenerative effects. This was the first study aiming to determine the in vitro efficacy of ultrasonic debridement combined with a H. perforatum extract against dental biofilms. Materials and Methods: A multispecies biofilm model comprising Streptococcus mutans, Porphyromonas gingivalis, Fusobacterium nucleatum, and Tannerella forsythia was established on bovine dentin discs. Biofilms were treated with saline solution (control), ultrasonic debridement alone, ultrasonic debridement combined with H. perforatum extract (0.5%), and ultrasonic debridement combined with chlorhexidine (0.12%). Biofilm biomass was quantified with the crystal violet assay, and total viable counts were determined by colony-forming unit (CFU) analysis. Quantitative PCR was used to assess the genomic load of P. gingivalis. Biofilm architecture and bacterial viability were further examined using confocal laser scanning microscopy (CLSM). Results: Ultrasonic debridement combined with H. perforatum extract significantly reduced biofilm biomass compared to saline irrigation (p < 0.001) and ultrasonic debridement alone (p < 0.01). Similar reductions were observed for viable bacterial counts and P. gingivalis genomic load. The antimicrobial effect of the plant extract was comparable to that of chlorhexidine, with only minor differences in efficacy. Confocal microscopy confirmed marked disruption of biofilm architecture and decreased bacterial viability following treatment with the plant extract. Conclusions: Within the limitations of this in vitro model, H. perforatum extract demonstrated measurable antibiofilm activity when used as an adjunct to ultrasonic debridement. These findings provide proof-of-concept evidence supporting the antimicrobial potential of this plant-derived extract under controlled laboratory conditions. Further preclinical studies and well-designed clinical investigations are required to determine its therapeutic relevance in periodontal treatment. Full article

Background and Objectives: Many patients present with urgent endodontic conditions characterized by pain and swelling, requiring prompt intervention. Failure to return for definitive root canal treatment (RCT) after urgent care can compromise tooth prognosis. This study examined the frequency and diagnostic patterns of urgent endodontic visits at a university dental college and evaluated predictors of follow-up after urgent treatment, considering demographic, anatomical, and clinical factors. Materials and Methods: A retrospective cohort analysis of 1619 patient records (August 2023–May 2025) was conducted. Data on urgency type, pulpal/periapical diagnosis, tooth characteristics, urgent treatment modality, and follow-up attendance were collected. Descriptive statistics and chi-square tests were used to assess bivariate associations. Multivariable logistic regression was performed to evaluate factors associated with completing follow-up after urgent care. Results: Approximately 50.2% of visits involved urgent endodontic care, most commonly symptomatic irreversible pulpitis (SIP) with symptomatic apical periodontitis (SAP), particularly in posterior teeth. Pulpectomy was the most frequently provided urgent treatment. Overall, 72.8% of urgent-care patients returned for completion of RCT (overall OR = 2.67). While urgency incidence and follow-up rates did not differ by gender, arch, or region, gender-stratified comparisons within urgent cases showed significant differences by arch and region. In multivariate analysis, mandibular teeth demonstrated higher odds of follow-up than maxillary teeth, whereas gender and region showed no association. Patients diagnosed with asymptomatic irreversible pulpitis (AIP)/SAP had lower odds of returning, and those treated with canal debridement with occlusal reduction (CD/OD) were also less likely to complete treatment. No other diagnostic or treatment categories showed significant associations. Conclusions: In this university-based cohort, urgent endodontic visits were common and primarily involved SIP/SAP. While the overall follow-up rate was high, certain diagnostic and treatment scenarios, specifically AIP/SAP and CD/OD, were associated with a reduced likelihood of returning for completion of RCT. Given the study’s limitations, these findings should be interpreted with caution. Full article

Background: This retrospective study assessed long-term survival outcomes of severely periodontally compromised mandibular incisors (≥50% bone loss) following initial periodontal treatment and a structured recall protocol. Methods: Ninety-three patients with ≥50% bone loss in all mandibular incisors were treated in a private practice over a 32-year period by the same periodontist. Following initial treatment, patients were assigned 6- or 12-month recall intervals based on response and motivation. The baseline was set after subgingival debridement (visit 3). Last follow-up visit (LFV) in this study was defined as follows: the last control visit of the patients done by the periodontist. ‘Survival’ was divided into 3 groups: complete survival (CS), all incisors were still present, and partial survival (PS), one or two incisor(s) were lost. Total failure (TF) involved instances in which all incisors were lost. Effective survival was monitored when an extracted tooth was repositioned and stabilized with a splint, ensuring preservation of function. Only 9.7% of patients needed a mandibular incisal splint. For reasons of consistency the CPITN was used. Statistical analysis was performed in R. The significance level was set at α = 0.05. Event-free patients can be considered as uninformative censoring, all with the same probability of risk, as they all were still in follow-up at the time of informed consent approval. Results: A total of 93 patients were included in the study. The mean follow-up was 17.7 years. At the last visit, 79.6% of patients retained all incisors, with an effective survival rate of 89.2%. Regarding the survival probability over time, after 15 years, it is 91% (95% CI: 0.86–0.98), and after 20 years, it is 78% (95% CI: 0.69–0.90). The effective survival probability over time after 15 years was 95% (95% CI: 0.91–1.0), and after 20 years, it was 89% (95% CI: 0.81–0.98). Compliance significantly influenced survival (p = 0.007), whereas the number of occluding units did not (p = 0.226). The total amount of teeth lost during the entire follow-up period showed a statistically significant difference compared to survival (p < 0.001). The general periodontal health of the patient population presented a shift from CPITN 3 to the 0–2 group. Conclusions: Severely compromised mandibular incisors demonstrate high long-term survival rates with appropriate therapy. After 20 years the survival probability was 78%, and the effective survival probability, 89%, underscoring the critical role of lifelong periodontal care. Mandibular incisor preservation over long-term follow-up is highly achievable. Full article

Periodontitis is a highly prevalent chronic inflammatory disease initiated by dysbiotic biofilms and sustained by an exaggerated host immune response, for which scaling and root planing (SRP) remains the cornerstone of therapy. However, mechanical debridement alone may be insufficient to fully resolve inflammation in complex cases and in susceptible patients. In this context, natural products and host modulatory strategies have emerged as potential adjunctive therapies owing to their antimicrobial, anti-inflammatory, antioxidant, and immunomodulatory properties. This systematic review and meta-analysis aimed to evaluate the effectiveness of natural products used as adjuncts to SRP on periodontal clinical outcomes. Comprehensive electronic searches were conducted in MEDLINE/PubMed, Scopus, Web of Science, Cochrane CENTRAL, Embase, SciELO, and Google Scholar through December 2025, and randomized controlled clinical trials were included. Ninety studies were eligible for qualitative synthesis, and thirty-three were incorporated into the meta-analysis. The interventions encompassed a broad spectrum of plant-derived, host-modulatory and nutraceutical compounds, including curcumin, resveratrol, propolis, Aloe vera, green tea catechins, and omega-3 fatty acids, administered via local, systemic, or rinse-based approaches. Meta-analytic findings demonstrated that adjunctive natural products significantly enhanced probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain compared with SRP alone, with additional improvements in gingival inflammation and bleeding outcomes; however, substantial heterogeneity was observed among studies. Overall, natural products provide measurable adjunctive benefits to SRP in the management of periodontitis, although further well-designed, standardized, and long-term randomized trials are necessary to support their routine clinical implementation. 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