Search Results (650)

Background/Objectives: This prospective observational cohort study aimed to evaluate the influence of heated tobacco (HT) and electronic cigarettes (ECs) on bone remodeling markers such as receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG), and periodontal status, at baseline and at 3 months after initial periodontal therapy. Methods: The sample comprised 236 participants (130 women, 106 men; mean age 38.96 ± 7.69 years), distributed across non-smokers (n = 72), heated tobacco/HT product users (n = 83), and electronic cigarette/EC users (n = 81). For each patient, the periodontal charting included periodontal probing depth (PPD), bleeding on probing (BOP), and clinical attachment loss (CAL). Unstimulated saliva samples were analyzed for RANKL and OPG levels. All patients underwent nonsurgical periodontal therapy (scaling and root planing). Between-group comparisons were performed using the Kruskal–Wallis test followed by Bonferroni-adjusted pairwise comparisons, while within-group changes over time were assessed using the Wilcoxon signed-rank test. To complement the primary nonparametric analyses, two-way mixed-design ANOVA and ANCOVA models adjusted for baseline values and periodontitis stage were performed as sensitivity analyses. Statistical significance was set at p < 0.05. Results: At baseline, both product user groups exhibited significantly higher PPD (p = 0.005) and CAL (p = 0.001) compared with non-smokers, with no differences between HT and EC users. Salivary RANKL levels were significantly higher in HT and EC users than in non-smokers, and OPG levels did not differ significantly. Following non-surgical periodontal therapy, all parameters improved significantly across groups (p < 0.001). At the 3-month follow-up, both product user groups maintained higher PPD (p = 0.008), CAL (p = 0.001), and salivary RANKL levels, compared with non-smoking individuals (p < 0.001). The RANKL/OPG ratio remained significantly different only for EC users compared with non-smokers (p < 0.001). Conclusions: HT and EC use were associated with differences in periodontal parameters and higher RANKL levels, while differences in the RANKL/OPG ratio were observed in EC users compared with non-smokers. Non-surgical periodontal therapy improved clinical parameters and reduced the RANKL/OPG ratio, highlighting the importance of biofilm control. Full article

Impacted mandibular third molars present a common challenge in oral surgery, often associated with postoperative complications such as delayed healing and periodontal defects; therefore, optimizing adjunctive therapies is clinically important. In this study, we aimed to evaluate the efficacy of platelet-rich fibrin (PRF) and preoperative azithromycin in modulating inflammation and enhancing wound healing following surgical extraction of impacted mandibular third molars. In this prospective clinical study, healthy subjects aged 18–50 years were randomly assigned to three groups: a control group receiving standard postoperative amoxicillin therapy, a PRF group receiving PRF with standard therapy, and a PRF-plus-azithromycin group receiving PRF, standard therapy, and a single preoperative dose of azithromycin. Clinical parameters were assessed and cytomorphometric analysis was performed preoperatively and postoperatively. Clinical parameters generally improved over time in all groups (p < 0.001). Differences between groups were observed for interincisal distance, Landry Index, and pain scores, with a trend toward more favorable outcomes in the combined-therapy group. Cytomorphometric analysis revealed cellular alterations in the control group, relative stability in the PRF group, and intermediate changes in the combined-therapy group. Within the limitations of this study, the combination of PRF and preoperative azithromycin showed potential benefits in several postoperative outcomes. However, given the study design and sample characteristics, these findings should be considered preliminary and require confirmation in larger prospective studies before definitive clinical recommendations can be made. Full article

Objectives: To compare the adjunctive efficacy of a MicroRepair^® mouthwash containing an antibacterial complex (ABX), composed of cetylpyridinium chloride, magnolol, and honokiol, with 0.12% chlorhexidine (CHX) in the management of generalized plaque-induced gingivitis, assessing clinical periodontal parameters, salivary activated matrix metalloproteinase-8 (aMMP-8) levels, and patient-reported outcomes over 6 months. Methods: A randomized, controlled, parallel-group clinical trial included 40 systemically healthy adults with generalized gingivitis and was reported in accordance with CONSORT 2025 guidelines. Following professional oral hygiene according to the Guided Biofilm Therapy (GBT) protocol, participants were randomly allocated to ABX or 0.12% CHX, used twice daily for 14 days. Clinical parameters, including Full-Mouth Bleeding Score (FMBS, primary outcome), Full-Mouth Plaque Score (FMPS), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), Gingival Recession (REC), and Modified Lobene Stain Index (MLSI), were recorded at baseline, 2 weeks, 1, 3, and 6 months. Salivary aMMP-8 levels were assessed at baseline and 2 weeks. Heavy smokers were excluded, and smoking status was evaluated as a potential covariate. Non-parametric tests were applied (p < 0.05). Results: Both groups showed significant reductions in FMBS and FMPS over time (p < 0.05), with no intergroup differences for the primary outcome at any follow-up at the patient level. Patient-level analyses did not reveal consistent differences across secondary parameters. At the tooth level, lower FMPS values were observed in the trial group at 2 weeks and 1 month (p < 0.05), with earlier PPD reduction. CAL, and REC remained stable. Salivary aMMP-8 levels decreased significantly in both groups without intergroup differences. Patient-reported outcomes were comparable. Smoking status was balanced between groups and was not significantly associated with treatment allocation or the main clinical outcomes. Conclusions: No significant differences were observed between ABX and CHX for the main clinical and molecular outcomes, supporting its potential use as an adjunct in gingivitis management. Full article

Orthodontic pain, a fundamental biological response to mechanically induced tooth movement, is primarily associated with sterile inflammation and neurogenic processes within the periodontal ligament (PDL). Although photobiomodulation therapy (PBMT) has been widely investigated as a nonpharmacological approach for pain attenuation, its mechanisms of action remain incompletely understood, and current interpretations are often limited to peripheral anti-inflammatory effects. This review re-examines the biological basis of orthodontic pain by integrating evidence derived predominantly from in vitro and in vivo experimental studies. Particular emphasis is placed on neurogenic inflammation, neuropeptide regulation, and neuron–glia interactions along the trigeminal nociceptive pathway. PBMT can reduce periodontal inflammatory/neuropeptide-related markers and pain-related behaviors in selected models; however, evidence for direct central neuron–glia modulation remains largely marker-based and parameter-dependent. Direct functional validation of trigeminal circuit modulation (e.g., electrophysiological recordings or calcium imaging) remains limited in orthodontic pain models; thus, the proposed neuroimmune mechanisms should be interpreted as testable hypotheses for future work. By synthesizing mechanistic insights across multiple biological levels, this review proposes a broader framework for understanding PBMT-mediated pain modulation extending beyond conventional peripheral models. These perspectives may help clarify inconsistencies in the reported outcomes and provide a rationale for future hypothesis-driven experimental and translational research. Full article

The 2018 classification of periodontal and peri-implant diseases introduced a multidimensional diagnostic framework integrating staging, grading, and disease extent, representing a major advance over earlier severity-based systems. By incorporating structural destruction, treatment complexity, spatial distribution, and estimated risk of progression, the classification aimed to support more individualized and biologically informed diagnosis. However, increasing clinical application has revealed interpretive challenges, particularly in cases where different components of the system appear discordant. This perspective examines these challenges through a conceptual and clinical lens, focusing on the distinction between focal severity and overall disease burden in staging, the biological meaning of disease distribution, the interpretation of tooth loss as a historical rather than current indicator of disease status, and the need to differentiate between observed progression and risk-based modifiers in grading. Rather than reflecting deficiencies of the classification itself, these discordances are understood as a consequence of applying categorical systems to a biologically heterogeneous and temporally dynamic disease. A biologically grounded interpretive hierarchy is proposed, prioritizing observed tissue behavior and realized tissue destruction over probabilistic risk indicators while integrating structural parameters, historical outcomes, and susceptibility modifiers within their appropriate conceptual roles. This approach enhances diagnostic coherence and supports a more phenotype-oriented interpretation of periodontal disease. Full article

Background and Clinical Significance: Advanced periodontitis destroys tooth-supporting structures and causes pathologic tooth migration (PTM) and functional and esthetic repercussions. This report illustrates how non-surgical periodontal therapy (NSPT) addresses such concerns. Case Presentation: A 34-year-old woman (healthy, who quit smoking) complained of a space between her upper front teeth. Based on clinical and radiographic data, she had localized periodontitis stage III grade C with intrabony defects, deep pockets, and a diastema between teeth # 12 and 11. The treatment plan involved improvement of self-performed oral hygiene measures and NSPT. Initially, improvements in plaque, bleeding, and pocket depth scores were observed. Non-surgical re-treatment of residual sites was associated with further improvements and complete closure of the diastema, along with patient satisfaction with the outcome. Conclusions: The potential of NSPT in improving periodontal clinical parameters and the association with spontaneous tooth repositioning and apparent filling of intrabony defects radiographically is demonstrated, ultimately addressing the patient’s functional and esthetic concerns. Full article

Background: The association between oral health and gastrointestinal (GI) cancers has been primarily investigated within a periodontitis-centered framework. However, the potential contribution of cumulative oral disease burden, including dental caries and apical pathology, remains insufficiently explored. The Decayed, Missing, and Filled Teeth (DMFT) index reflects lifetime exposure to oral microbial dysbiosis and chronic inflammation. Methods: This retrospective exploratory study included patients with GI cancers referred for perioperative oral screening and management at a tertiary care center between 2015 and 2025. Oral health was evaluated using the DMFT index, periodontal probing depth, and radiographically diagnosed apical periodontitis. Age-stratified DMFT and periodontal parameters were compared with national reference data, while apical periodontitis prevalence was descriptively assessed. Results: Patients with GI cancers demonstrated higher DMFT values than national averages across most adult age groups. The prevalence of periodontal pockets (≥4 mm and ≥6 mm) was also elevated. Apical periodontitis was common, affecting 46.3% of patients, with some age groups exceeding 50%. Overall, these findings indicate oral disease clustering with coexisting chronic oral conditions. Conclusions: Patients with GI cancers exhibit substantial oral disease burden, including increased caries experience, periodontal pathology, and apical lesions. These findings suggest that the oral–gastrointestinal cancer relationship may extend beyond a periodontitis-centered paradigm, and that cumulative oral disease burden—including cariogenic processes—may represent an underrecognized component of this axis. The DMFT index may serve as a surrogate marker of lifelong oral inflammatory exposure. While causal relationships cannot be established, this study provides a basis for future mechanistic and longitudinal investigations. Full article

Background: The biological response of the periodontal ligament (PDL) following endodontic treatment remains insufficiently investigated. This systematic review aimed to evaluate the influence of endodontic treatment modalities on PDL-related healing outcomes and periapical tissue repair. Methods: A systematic review was conducted according to PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, and the Cochrane Library were searched for randomized clinical trials published between 2015 and 2025. Studies evaluating the effects of endodontic interventions on clinical, radiographic, or biological outcomes associated with PDL healing. Risk of bias was assessed using the Cochrane RoB 2 tool. Results: Ten randomized clinical trials involving approximately 710 participants were included. Endodontic treatment was generally associated with favorable healing outcomes, reflected by reductions in periapical lesion size, improvement of radiographic parameters, and resolution of clinical symptoms. Single-visit and multiple-visit treatments demonstrated comparable long-term healing outcomes, although single-visit protocols were associated with increased short-term postoperative discomfort. Activated irrigation techniques appeared to enhance healing compared with conventional irrigation methods. Most studies were judged as having some concerns regarding risk of bias. Conclusions: Current evidence suggests that endodontic treatment can promote favorable healing of the periodontal ligament–periapical complex through effective infection control and resolution of inflammation. However, the certainty of evidence remains moderate because of methodological heterogeneity and the limited availability of studies directly assessing biological PDL outcomes. Further well-designed randomized clinical trials with standardized outcome measures and longer follow-up periods are required. Full article

Background/Objectives: Orthodontic treatment induces controlled mechanical forces that alter the periodontal environment, including changes in oral microbiota composition and activation of local inflammatory pathways. Despite the widespread and growing use of orthodontic appliances across all age groups, the magnitude, timing, and multi-domain biological impact of these changes have not been comprehensively quantified in a single systematic synthesis. This systematic review and meta-analysis aimed to synthesize the available evidence on periodontal clinical parameters, oral microbiota composition, and local inflammatory biomarkers associated with orthodontic treatment using fixed appliances and clear aligners, and to provide a structured, GRADE-rated evidence base for clinical practice. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, and Web of Science were searched from inception to March 2026. Prospective cohort studies, longitudinal clinical studies, and randomized controlled trials evaluating periodontal parameters, oral microbiota, and inflammatory biomarkers during orthodontic treatment were included. Quantitative synthesis was performed using mean differences or standardized mean differences with 95% confidence intervals, primarily assessing within-group (pre–post) changes. Results: Eighteen studies (n = 812 patients; follow-up 3–12 months) met inclusion criteria. Fixed orthodontic appliances were consistently associated with transient increases in plaque index (MD 0.45, 95% CI 0.32–0.58; I² = 62%), gingival index (MD 0.38, 95% CI 0.25–0.51; I² = 55%), and bleeding on probing (MD 15.2%, 95% CI 10.1–20.3%; I² = 48%), particularly during early treatment phases. Microbiological analyses demonstrated within-group shifts toward increased prevalence of periodontopathogenic species (Streptococcus mutans OR 2.45, 95% CI 1.89–3.18; Porphyromonas spp. OR 2.14, 95% CI 1.67–2.75) in patients treated with fixed appliances. Local inflammatory responses were characterized by elevated IL-1β (MD 1.2, 95% CI 0.8–1.6) and IL-6 (MD 0.9, 95% CI 0.6–1.2) in gingival crevicular fluid. Certainty of evidence was rated moderate for plaque and gingival indices and low for microbiological and inflammatory outcomes (GRADE). Conclusions: Orthodontic treatment—particularly with fixed appliances—is associated with transient, reversible deterioration of periodontal indices, shifts toward a more dysbiotic oral microbiome, and elevation of local inflammatory mediators in gingival crevicular fluid during active treatment phases. These changes are manageable through structured preventive protocols and regular periodontal monitoring. Future prospective studies with concurrent control groups and standardized multi-domain outcome measures are needed to better define the magnitude and reversibility of these biological responses. PROSPERO: CRD420261336117. Full article

Indole, a volatile metabolite produced by bacterial tryptophanase (encoded by tnaA) during tryptophan metabolism, contributes to oral malodor and may influence the progression of periodontitis. However, the genetic features underlying strain-specific indole production and its association with bacterial virulence remain unclear. Analysis of a previously published periodontitis cohort revealed that periodontitis severity was associated with salivary indole-related metabolic signatures, which were positively correlated with the abundance of Porphyromonas gingivalis (P. gingivalis). Further analysis showed that W83, a reference strain previously reported to exhibit relatively high virulence-associated characteristics, produced significantly higher levels of indole than ATCC 33277 under the experimental conditions. Comparative genomic analysis of 36 complete P. gingivalis genomes showed that the amino acid sequences of TnaA were highly conserved. However, the transposase region adjacent to tnaA differed among strains: previously reported high-virulence strains, including W83, W50, and A7436, harbored the IS5-family transposase ISPg1, whereas several low-virulence reference strains carried the IS982-family transposase IS195. In saliva samples from periodontitis patients, ISPg1 expression was positively correlated with tnaA expression, and both were associated with periodontal clinical parameters. Together, these findings indicate that transposase-associated genomic variation near tnaA is associated with strain-specific tryptophan-indole metabolism, virulence-associated gene expression, and periodontal clinical parameters, while direct causality remains to be established in future functional studies. Full article

Background/Objectives: Systemic diseases such as diabetes mellitus and hepatitis C virus infection are increasingly recognized as important modifiers of oral health. However, their combined impact, as well as the role of behavioral confounders such as smoking, remains insufficiently explored. This study aimed to evaluate oral health parameters in patients with diabetes and/or hepatitis C virus infection, to investigate the prevalence of oral mucosal conditions, and to identify independent predictors of xerostomia, with particular emphasis on glycemic control and smoking. Methods: A cross-sectional study was conducted on 66 patients, including 33 systemically affected individuals and 33 healthy controls. Clinical parameters included the number of teeth, tooth mobility, bleeding on brushing, xerostomia, and oral lichen planus. Glycemic control was defined by using glycated hemoglobin thresholds (controlled < 7%, uncontrolled ≥ 7%). Statistical analyses included non-parametric tests, Spearman correlation, and multivariate logistic regression. Results: Patients with diabetes exhibited significantly fewer teeth (p = 0.001), increased tooth mobility (p = 0.001), and a higher prevalence of gingival bleeding (p = 0.042). Hepatitis C virus infection was strongly associated with oral lichen planus (p = 0.009). Xerostomia was more prevalent in hepatitis C virus infection patients, but in multivariate analysis, smoking emerged as the only independent predictor (OR = 5.73; p = 0.014). Glycemic control was not independently associated with xerostomia after adjustment. Conclusions: Diabetes primarily influences periodontal destruction, while hepatitis C virus infection is associated with mucosal pathology. Smoking plays a dominant role in xerostomia and may confound associations attributed to systemic disease. These findings highlight the importance of integrated oral-systemic assessment and behavioral risk management. Full article

Background: Full-mouth disinfection (FMD) has been proposed as an effective non-surgical approach for the management of periodontitis; however, its clinical and microbiological outcomes in patients with depressive comorbidity remain insufficiently explored. Methods: This prospective study included 80 patients diagnosed with stage II periodontitis, allocated into two groups based on the presence or absence of depressive disorder. All participants underwent standardized FMD. Clinical parameters, including bleeding on probing and plaque index, together with subgingival bacterial load (total bacterial load, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia), were assessed at baseline and 12 weeks post-treatment using quantitative polymerase chain reaction. Microbiological data were log10-transformed prior to statistical analysis. Results: Significant reductions in both clinical and microbiological parameters were observed following treatment in both groups. Improvements in bleeding on probing and plaque index were accompanied by a marked decrease in total bacterial load and in the targeted periodontal pathogens. Patients with depressive disorder exhibited a higher baseline microbial burden; however, post-treatment reductions were comparable between groups. Moderate positive correlations were identified between total bacterial load and clinical parameters. Conclusions: FMD was associated with substantial short-term improvements in both clinical and microbiological outcomes in patients with stage II periodontitis. Depressive comorbidity did not appear to adversely influence treatment response. These findings support the role of biofilm control as a central component of periodontal therapy across different patient profiles. Full article

Background: Patient-reported outcome measures (PROMs) are essential for assessing postoperative morbidity and patient-centered treatment value after periodontal plastic surgery. This study evaluated PROMs following the modified coronally advanced tunnel (MCAT) combined with subepithelial connective tissue graft (SCTG) and different adjunctive biomaterials. Methods: This retrospective pooled secondary analysis included 64 patients treated for 275 gingival recessions using MCAT + SCTG with physiological saline (control), 24% EDTA, enamel matrix derivative (EMD), or cross-linked hyaluronic acid (HA). PROMs were the primary outcomes and included postoperative pain and swelling assessed using a 0–100 mm visual analogue scale (VAS), together with binary symptom measures recorded on days 1, 2, 4, 7, and 14. Patient satisfaction, esthetic perception, and willingness to recommend treatment were also assessed. Clinical and esthetic outcomes at 12 months served as reference parameters. Results: Early postoperative pain differed significantly between groups on days 1, 2, and 7 (p = 0.016, 0.024, and 0.033, respectively). Edema also varied significantly on days 2, 4, and 14 (p = 0.011, 0.001, and 0.001, respectively). The HA group showed lower pain scores on days 2 and 4, whereas EDTA was associated with greater early discomfort. Despite these differences, long-term satisfaction, esthetic perception, willingness to recommend treatment, and root coverage outcomes were high and comparable among groups (p > 0.05). Conclusions: MCAT + SCTG provides predictable and stable outcomes for multiple gingival recessions, regardless of adjunctive biomaterial. However, PROMs revealed differences in early postoperative morbidity, supporting their integration into clinical decision-making alongside clinician-reported outcomes. Full article

Background/Objectives: Gingival phenotype is considered an important factor influencing periodontal tissue response during orthodontic treatment; however, the association between orthodontic treatment history and gingival phenotype remains unclear. This study aimed to compare gingival phenotype between orthodontically treated individuals and untreated controls and to evaluate the factors associated with gingival phenotype, including periodontal status and oral hygiene habits. Methods: This cross-sectional comparative study included 180 individuals aged 18–35 years, who were divided into two groups according to orthodontic treatment history (history of orthodontic treatment, n = 90; untreated controls, n = 90). Gingival phenotype was assessed using the transparency method at the mid-buccal aspect of the mandibular central incisor. Periodontal parameters, including Plaque Index (PI), Gingival Index (GI), probing depth (PD), and keratinized gingival width (KGW), were recorded. Oral hygiene habits and behavioral factors were also evaluated. Binary logistic regression analysis was performed to identify factors associated with gingival phenotype. Statistical significance was set at p < 0.05. Results: No significant association was found between orthodontic treatment and gingival phenotype (p > 0.05). Periodontal parameters were comparable between groups; however, orthodontically treated individuals demonstrated significantly better oral hygiene habits (p < 0.05). Logistic regression analysis revealed that male sex (OR = 6.54, p < 0.001) and increased KGW (OR = 1.668, p = 0.003) were independently associated with a thick gingival phenotype. Conclusions: The findings indicate that gingival phenotype appeared to be more strongly associated with intrinsic anatomical factors, particularly sex and KGW, rather than orthodontic treatment. It was concluded that individualized assessment of gingival phenotype and controlled orthodontic tooth movement may contribute to periodontal preservation. Full article

Background: Custom-made subperiosteal implants have re-emerged as a valuable option for the rehabilitation of patients with severe maxillofacial atrophy and post-oncological defects. Despite advances in digital workflows and implant design, their unique anatomical, biological, and prosthetic characteristics pose specific challenges for long-term maintenance, and no dedicated standardized guidelines are currently available. Methods: This narrative review critically appraises the available literature on implant maintenance and related fields. A comprehensive search was conducted across PubMed, Scopus, and Web of Science, including studies on peri-implant maintenance, supportive periodontal therapy, full-arch and zygomatic implant rehabilitations, and subperiosteal implants. Due to the lack of direct evidence, a qualitative narrative synthesis was adopted to develop preliminary clinical considerations for maintenance of custom-made subperiosteal implants. These considerations should be interpreted as an expert-informed perspective rather than validated clinical guidelines. Results: Conventional maintenance protocols developed for endosseous implants are not directly transferable to subperiosteal implants due to differences in the implant–tissue interface, biomechanics, diagnostic parameters, and hygiene accessibility. Key challenges include the absence of a conventional peri-implant sulcus, possible implant exposure, complex prosthetic geometries, and potential susceptibility to biofilm accumulation in areas with limited access. Evidence from related fields highlights the importance of structured maintenance, individualized risk-based follow-up, effective biofilm control, and patient-specific home-care strategies. Conclusions: Preliminary evidence-informed clinical considerations for the maintenance of subperiosteal implants are proposed, with emphasis on plaque control, individualized follow-up, descriptive clinical monitoring, and hygiene-oriented prosthetic and surgical planning. These considerations are not intended as validated guidelines, but as a practical starting point for clinical reasoning in an area where dedicated evidence remains limited. Full article