Search Results (43)

Background: The aim of the present narrative review is to synthesize the available scientific evidence on the minimally invasive surgical techniques for periodontal regeneration preserving the entire papilla without dissection. Surgical treatment of intrabony defects may result in compromising the integrity of the interdental tissues and subsequent papilla loss. Therefore, it is indicated to investigate the approaches avoiding papillary incision over the osseous defect, thus optimizing wound healing conditions. Methods: Authors performed a search of literature via electronic databases such as PubMed, Web of Science, Cochrane, and Scopus, and extended by manual searching with a stop date of February 2025. Based on inclusion criteria only randomized clinical trials (RCT), cohort studies, case–control studies, and case series were included, and 106 records were initially identified. Various aspects of described novel approaches preserving the entire papilla were finally discussed. Results: A total of 12 studies were evaluated. There is a significant lack of randomized controlled clinical trials on minimally invasive techniques without incision in the papilla. However, numerous modifications of existing techniques have emerged, mainly in the form of case series and case reports with short-term data. Among them, some authors stated that the entire papilla preservation approaches may facilitate early soft tissue healing, reduce papilla trauma and the risk of gingival recession, minimize procedure time, improve flap stability, and alleviate discomfort and side effects, while others reported similar outcomes to conventional approaches and emphasize the need for further comparative clinical trials. Conclusions: Preserving papilla integrity and the soft tissue profile is essential for minimizing complications, especially in the esthetic zone. Within the limitations of this narrative review, presented findings emphasize the effectiveness of entire papilla preservation techniques in preventing post-surgery tissue loss compared to conventional incisions and flaps. Randomized controlled trials with longer follow-up periods and larger sample sizes are necessary to validate the efficacy of these approaches in comparison to established papilla preservation techniques. Full article

Background and Objectives: This scoping review aimed to identify and synthesize current evidence on the clinical applications of artificial intelligence (AI) in periodontology, focusing on its potential to improve diagnosis, treatment planning, and patient care. Materials and Methods: A comprehensive literature search was conducted using electronic databases including PubMed-MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Web of Science™ Core Collection. Studies were included if they met predefined PICO criteria relating to AI applications in periodontology. Due to the heterogeneity of study designs, imaging modalities, and outcome measures, a scoping review approach was employed rather than a systematic review. Results: A total of 6394 articles were initially identified and screened. The review revealed a significant interest in utilizing AI, particularly convolutional neural networks (CNNs), for various periodontal applications. Studies demonstrated the potential of AI models to accurately detect and classify alveolar bone loss, intrabony defects, furcation involvements, gingivitis, dental biofilm, and calculus from dental radiographs and intraoral images. AI systems often achieved diagnostic accuracy, sensitivity, and specificity comparable to or exceeding that of dental professionals. Various CNN architectures and methodologies, including ensemble models and task-specific designs, showed promise in enhancing periodontal disease assessment and management. Conclusions: AI, especially deep learning techniques, holds considerable potential to revolutionize periodontology by improving the accuracy and efficiency of diagnostic and treatment planning processes. While challenges remain, including the need for further research with larger and more diverse datasets, the reviewed evidence supports the integration of AI technologies into dental practice to aid clinicians and ultimately improve patient outcomes. Full article

Background: The association between diabetes and periodontal disease is well established, but its impact on intrabony periodontal defects remains unclear. Aims: This study examines the relationship between diabetes and intrabony periodontal defects using cone beam computed tomography (CBCT). Methods: A retrospective analysis of 99 CBCT images from Imam Abdurrahman bin Faisal University (2010–2022) was conducted. Intrabony periodontal defects were assessed, and logistic regression was used to analyze their association with diabetes. Results: Intrabony periodontal defects were detected in 66% of the sample, with 36% exhibiting multiple defects. Crude logistic regression showed a significant association between diabetes and intrabony periodontal defects (OR 3.986, 95% CI 1.454–10.922) and defect count (OR 3.382, 95% CI 1.430–8.003). However, multiple regression analysis did not confirm diabetes as an independent predictor (adjusted OR 0.740, 95% CI 0.087–6.314). Conclusions: Diabetes was not significantly associated with the prevalence or number of intrabony periodontal defects after adjusting for the confounders. However, these findings highlight the multifactorial nature of periodontal bone loss and the need for comprehensive patient assessment. Clinically, this underscores the importance of integrating both systemic and local periodontal evaluations in diabetic patients to improve early detection and personalized treatment planning. Further research with larger, more diverse samples and integrated clinical assessments is needed to refine our understanding of this relationship and enhance patient management. Full article

Introduction: The physiological process of wound healing is a complex and dynamic series of events that aims to restore damaged tissues to their original structure and function. Platelet-rich plasma (PRP), an autologous blood-derived product, is characterized by a high concentration of platelets suspended in a small volume of plasma, along with a complete array of coagulation factors at physiological concentrations. Beyond platelets, PRP contains a significant quantity of bioactive growth factors, such as platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and transforming growth factor-beta (TGF-β), all of which are crucial mediators of tissue repair and osteogenesis. Due to these properties, PRP has garnered considerable attention in oral surgery, where the efficient regeneration of both hard and soft tissues is critical for the optimal therapeutic outcomes. Objectives: This systematic review aimed to critically evaluate the efficacy of PRP in oral surgical procedures, with particular emphasis on its role in the regeneration of both soft and hard tissues, as well as its clinical outcomes. Furthermore, the review sought to identify the diverse surgical applications of PRP and assess the impact of its use in conjunction with grafting materials on regenerative outcomes. Methods: A comprehensive systematic review was conducted, analyzing articles published within the last decade regarding the application of PRP in oral surgery, specifically focusing on periodontal, regenerative, and implant-related procedures. Studies were selected based on rigorous inclusion criteria, assessing the utilization of PRP across different clinical settings. Results: Thirteen relevant studies were included, which were categorized as follows: three studies involving implant surgery, three studies focusing on third molar extractions, two studies on regenerative surgery, two studies addressing periodontal surgery, one study examining intrabony periodontal defects, and two studies on ridge augmentation procedures. The majority of studies reported modest improvements in clinical parameters such as periodontal probing depth and clinical attachment level (CAL). Furthermore, significant positive outcomes were observed in soft tissue healing, with notable enhancements in bone density. These results suggest that PRP may facilitate the healing process, particularly in soft tissues, while also promoting bone regeneration to a degree. Conclusions: The findings of this systematic review underscore the potential of PRP as a valuable adjunct in oral surgery, demonstrating significant benefits in the regeneration of soft tissues and, to a lesser extent, hard tissues. Notably, the standalone application of PRP did not yield substantial improvements in regenerative outcomes. However, when PRP was used in combination with grafting materials, more pronounced benefits were observed, indicating a synergistic effect that enhances both soft and hard tissue regeneration. These findings support the rationale for incorporating PRP into clinical practice, particularly in conjunction with grafting materials, to optimize patient outcomes in oral surgery. Further research, particularly involving larger sample sizes and long-term follow-ups, is necessary to fully elucidate the optimal clinical applications and mechanistic pathways of PRP in oral regenerative procedures. Full article

Background: This study aimed to assess the effectiveness of a modified entire papilla preservation technique (MEPPT) for treating isolated intrabony defects in patients with stage III periodontitis. Material and Methods: Fifteen patients with 15 interdental intrabony defects were treated with a MEPPT using enamel matrix derivative and allogenic bone. Their probing pocket depth (PPD), clinical attachment level (CAL), gingival recession (GR), keratinized tissue width (KTW), defect depth (DD), full-mouth plaque score (FMPS), full mouth bleeding score (FMBS), radiographic images (radiographic angles, BF and LDF) and intrasurgical parameters were assessed at baseline and 3 years postsurgery. Standardized measurements were taken to evaluate the defect characteristics and treatment outcomes. Results: At 3 years, significant improvements from baseline were maintained. Probing pocket depth (PPD) decreased from 7.03 ± 1.61 mm to 3.33 ± 0.89 mm (p < 0.0001), clinical attachment level (CAL) improved to 3.08 ± 1.16 mm (p < 0.001) and defect depth (DD) decreased from 4.59 ± 1.24 mm to 0.38 ± 0.31 mm (p < 0.001). The changes in gingival recession and keratinized tissue were not statistically significant. The results demonstrate sustained clinical stability over a 3-year period. Conclusions: Within the limitations of this study, the findings suggest that the modified entire papilla preservation technique (MEPPT) in conjunction with enamel matrix proteins and allogenic bone grafting is an effective approach for the treatment of intrabony defects, leading to statistically significant and sustained clinical improvements over a 3-year period. The study protocol was registered in ClinicalTrials.gov ID NCT05029089. Full article

The aim of this study was to compare the efficacy of the guided tissue regeneration (GTR) of periodontal infrabony defects using the frozen radiation-sterilized allogenic bone graft (FRSABG) versus deproteinized bovine bone mineral (DBBM) 5 years after treatment. The association between patients’ compliance and periodontitis recurrence with 5-year outcomes was also evaluated. Thirty infrabony defects in 15 stage III/IV periodontitis patients were randomly allocated to the FRSBAG group (tests) or the DBBM group (controls). Between 1 and 5 years, one patient was lost to follow-up and one tooth was extracted due to root fracture. No tooth was extracted for periodontal reasons. Consequently, 13 teeth in test sites and 14 teeth in control sites were available for the 5-year analysis. The clinical attachment level gain (CAL-G, primary outcome), probing pocket depth (PPD), radiographic defect depth (DD), and linear defect fill (LDF) were examined at baseline and 5 years post-surgically. Both groups showed statistically significant improvements in all evaluated clinical and radiographic parameters at 5 years, with insignificant intergroup differences. CAL-Gs were 4.46 ± 2.07 mm in the FRSBAG group, and 3.86 ± 1.88 mm in the DBBM group (p = 0.5442). In six (43%) patients, we observed periodontitis recurrence, among whom two (33.33%) participated regularly in supportive periodontal care (SPC) and the other four (66.7%) did not take part in SPC. A regression analysis revealed that periodontitis recurrence was a significant predictor of CAL loss and DD increase. FRSBAG and DBBM were both equally effective 5 years after the GTR of infrabony defects. Within the limitations of the present study, its outcomes advocate that both grafts may be considered as a viable option based on patient preferences and clinical considerations. Full article

In dental diagnosis, evaluating the severity of periodontal disease by analyzing the radiographic defect angle of the intrabony defect is essential for effective treatment planning. However, dentists often rely on clinical examinations and manual analysis, which can be time-consuming and labor-intensive. Due to the high recurrence rate of periodontal disease after treatment, accurately evaluating the radiographic defect angle of the intrabony defect is vital for implementing targeted interventions, which can improve treatment outcomes and reduce recurrence. This study aims to streamline clinical practices and enhance patient care in managing periodontal disease by determining its severity based on the analysis of the radiographic defect angle of the intrabony defect. In this approach, radiographic defect angles of the intrabony defect greater than 37 degrees are classified as severe, while those less than 37 degrees are considered mild. This study employed a series of novel image enhancement techniques to significantly improve diagnostic accuracy. Before enhancement, the maximum accuracy was 78.85%, which increased to 95.12% following enhancement. YOLOv8 detects the affected tooth, and its mAP can reach 95.5%, with a precision reach of 94.32%. This approach assists dentists in swiftly assessing the extent of periodontal erosion, enabling timely and appropriate treatment. These techniques reduce diagnostic time and improve healthcare quality. Full article

Background: Periodontal intra-bony defects are challenging conditions in dental practice, often requiring regenerative approaches for successful treatment. This clinical study aimed to compare the effectiveness of plasma rich in growth factors (PRGF) versus xenogenic bone graft (BXG) in addressing intra-bony defects. Methods: Forty patients aged between 30 and 50 years presenting with generalized periodontitis were included. The study assessed various parameters, including relative attachment level (RAL); probing pocket depth (PPD); gingival marginal level (GML); intra-bony defect depth (IBDD) at baseline, 3, and 6 months; and level of pain, post-operative bleeding, and swelling, as patient-reported outcomes during the first seven days post operation. Results: The results revealed that both PRGF and BXG treatments led to significant reductions in IBDD over the 6-month study period. PRGF demonstrated significant advantages in GML enhancement and post-operative pain management during the initial post-treatment days. However, BXG showed a significantly greater reduction in IBDD compared to PRGF. Post-operative bleeding and swelling levels were comparable between the two treatments. Conclusions: These findings underscore the efficacy of both PRGF and BXG in periodontal regeneration, with treatment decisions guided by patient-specific factors and clinical goals. Full article

Intrabony defects can be the result of parodontitis. In this study we aimed to examine how clot stability is affected by different infrabony defect angles and superficial treatments in regenerative surgery. Methods: Thirty single-root extracted teeth were cut to obtain a section from each tooth. This section was placed in an artificial model containing an infrabony defect with three walls in order to achieve 10 models at angles of 25°, 37°, and 50°. Five root samples for every angle were not subjected any treatment (NT) and five were subjected to root conditioning with a neutral pH solution of ethylenediaminetetraacetic acid (EDTA) at 24%, applied for 2 min. Venous blood was put into the artificial models containing the root sections, and these were placed in an incubator at a constant temperature of 37 °C for 2 h. Samples were analyzed by laser confocal microscopy. Results: All samples exhibited signs of retraction. The EDTA group exhibited a plateau trend for infrabony defects, while in the NT group, there was a statistically significant difference between clot retraction and the increase in defect amplitude. Conclusion: The greater the angle of the infraosseous defect, the higher the rate of clot retraction. This showed that EDTA could reduce the influence of the angle of the infraosseous defect. Full article

Background: This study aimed to evaluate alterations in the concentrations of matrix metalloproteinase-9 (MMP-9) and interleukin-8 (IL-8) within gingival crevicular fluid (GCF) extracted from the intrabony periodontal defect site before and after minimally invasive regenerative surgery, with or without supplemental laser application. The surgical procedure was performed using the modified minimally invasive surgical technique (M-MIST). Methods: Thirty-eight patients, each presenting with a single vertical defect, were randomly assigned to either the test (M-MIST + Er:YAG + Nd:YAG) or the control group (M-MIST). IL-8 and MMP-9 levels (primary outcomes of the study) were assessed prior to therapy, after 2 and 4 weeks, and 6 months following the surgical procedure by means of dedicated ELISA kits. Results: Both procedures were clinically effective as evidenced by probing depth (PD) reduction and clinical attachment level (CAL) gain at the 6-month follow-up. No statistical differences were observed in the levels of MMP-9 and IL-8 between the groups at any time point assessed. The changes in the level of MMP-9 and IL-8 over time were not statistically significant in any group. IL-8 was positively correlated with MMP-9 in the control group throughout the study and in the test group 2 weeks and 6 months post-op. Conclusions: Within the limitations of this study, the additional application of Er:YAG + Nd:YAG lasers alongside the M-MIST procedure did not enhance the clinical and biochemical treatment outcomes compared to M-MIST alone. Full article

Background: The aim of this study was to retrospectively evaluate the 3-year radiographic outcomes of periodontal intrabony defects treated with non-surgical subgingival therapy (NST), assessing radiographic bone gain (RBG) through experimental digital software, named “Bone Defect Analysis (BDA)”. Methods: The study included 17 intrabony defects in 14 patients. BDA software (version 1) was used on radiographs to calculate RBG (in %) and variations in defect angle (in °) between baseline (T0) and 3-year follow-up (T1). Soft tissue conditions were registered, reporting bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL). Defects were analyzed according to angles less (group A) or greater (group B) than 30°. Results: Nine and eight defects were, respectively, analyzed in groups A and B. Three years after treatment, an average RBG of 12.28% was found overall, with 13.25% and 10.11% for groups A and B, respectively (p = 0.28). Clinically, a mean CAL of 6.05 mm at T1 (from 10.94 mm at T0) was found, with 6.88 mm and 5.12 mm in groups A and B, respectively (p = 0.07). Conclusions: BDA software demonstrated predictability in the evaluation of bone variations after NST, revealing better clinical findings for intrabony defects with an initial smaller angle. Full article

Background and Objectives: Unfavorable intrabony defects (IBDs) are associated with the progression of periodontal disease and tooth loss. Growing scientific evidence has demonstrated the effectiveness of platelet concentrations in periodontal treatment. The aim of our study was to demonstrate the non-inferiority of an autogenous bone graft (ABG) associated with leukocyte- and platelet-rich fibrin (L-PRF) compared to ABG + Collagen Membrane in the treatment of IBDs. Material and Methods: Sixty-four patients with at least one IBD were randomly assigned to two groups: ABG+L-PRF and CM+ABG. Clinical and radiographic evaluations were performed at baseline and 12-month follow-up. Clinical attachment level (CAL), gingival recession (GR), probing pocket depth (PPD), and radiograph defect bone level (DBL) were compared between the two treatments. To evaluate the effectiveness of ABG+L-PRF, a non-inferiority margin of =1 mm (−1 mm for GR) was chosen; a second non-inferiority margin of =0.5 mm (−0.5 mm for GR) was set for clinical relevance. Results: At 12-month follow up, both treatments showed clinical and radiographic improvements. The 90% confidence intervals of the CM+ABG–L-PRF+ABG mean difference for CAL gain (−0.0564 mm [−0.316 to 0.203]), DBL gain (−0.433 mm [−0.721 to −0.145]), and PPD reduction (0.232 mm [0.015 to 0.449]) were below the 0.5 mm non-inferiority margin; the GR increase (0.255 mm [0.0645 to 0.445]) stayed above the −0.5 mm. Conclusions: the L-PRF+ABG treatment of unfavorable IBDs is non-inferior with respect to the CM+ABG therapy for CAL gain, but with a lower GR, a slightly higher PPD, and DBL gain. Full article

The aim of this study was to test the molecular expression profile (senescence-associated secretory phenotype; SASP) in gingival crevicular fluid (GCF) prior to surgery in relation to the distribution of clinical success of periodontal regeneration. Forty consecutive patients presenting sites with residual probing pocket depth (PPD) ≥ 6 mm and intrabony defects ≥ 3 mm were treated through a minimally invasive surgical technique. Pre-operatively, GCF was sampled for inflammatory biomarker analysis related to SASP [interleukin (IL)-1β, IL-6, and IL-12; matrix-metalloproteinases (MMP)-8 and -9]. Better or worse responders were classified depending on the achievement of a composite outcome measure at 1-year [COM; PPD ≤ 4 mm and clinical attachment gain (CAL) gain ≥ 3 mm]. Correlation analyses and logistic regression models were performed. Periodontal regeneration led to significant improvements in mean clinical and radiographic parameters. Teeth achieving COM presented significantly lower amounts of SASP factors compared with non-successful teeth. Higher CAL gain, PPD reduction, and radiographic bone fill were negatively correlated with IL-1β and MMP-8 and -9 (p < 0.001), while IL-12 showed a direct relationship with CAL gain (p = 0.005) and PPD reduction (p = 0.038). Sites expressing higher SASP expression in the GCF before periodontal regeneration achieved worse clinical and radiographic outcomes. Full article

Platelet-rich fibrin has become increasingly popular in recent years due to its remarkable capacity to accelerate the post-surgery wound healing process, reduce inflammation, and promote tissue repair. This study aimed to perform a meta-analysis to evaluate the effect of platelet-rich fibrin in mixture form with bone substitute, as a membrane, or in combination. A comprehensive search using a combination of controlled vocabulary (MeSH) and free-text terms was undertaken by two reviewers to identify published randomized clinical trials. Three major electronic databases (Medline via PubMed, Cochrane database, and Embase) and the clinical trials registry (clinicaltrials.gov) were searched up to 9 July 2023. The results of the meta-analysis showed that the pooled standardized mean difference of probing depth for platelet-rich fibrin was 0.61 (95% CI, 0.33 to 0.88). The results of the meta-analysis showed that the mean difference in clinical attachment level for platelet-rich fibrin was 0.68 (95% CI, 0.35 to 1.01). The results of the meta-analysis showed that the mean difference in bone fill for platelet-rich fibrin was 0.50 (95% CI, 0.23 to 0.78). In conclusion, the study found that platelet-rich fibrin was effective as adjunct to periodontal regeneration. Full article

Background: The utilization of regenerative techniques in periodontology involves tailoring tissue engineering principles to suit the oral cavity’s unique environment. Advancements in computer-assisted technology, specifically utilizing cone beam computed tomography (CBCT), enabled the fabrication of 3D-printed scaffolds. The current review aims to explore whether 3D-printed scaffolds are effective in promoting osteogenesis in patients with periodontal defects. Methods: A thorough exploration was undertaken across seven electronic databases (PubMed, Scopus, ScienceDirect, Google Scholar, Cochrane, Web of Science, Ovid) to detect pertinent research in accordance with specified eligibility criteria, aligning with the PRISMA guidelines. Two independent reviewers undertook the screening and selection of manuscripts, executed data extraction, and evaluated the bias risk using the Newcastle–Ottawa Scale for non-randomized clinical trials and SYRCLE’s risk of bias tool for animal studies. Results: Initially, 799 articles were identified, refined by removing duplicates. After evaluating 471 articles based on title and abstract, 18 studies remained for full-text assessment. Eventually, merely two manuscripts fulfilled all the eligibility criteria concerning human trials. Both studies were prospective non-randomized clinical trials. Moreover, 11 animal studies were also included. Conclusions: The use of multidimensional, 3D-printed, customized scaffolds appears to stimulate periodontal regeneration. While the reported results are encouraging, additional studies are required to identify the ideal characteristics of the 3D scaffold to be used in the regeneration of periodontal tissue. Full article