Search Results (1,528)

Background/Objectives: Prepubertal localized aggressive periodontitis/LPP is an extremely rare but extremely fast-progressing form of periodontal disease involving systemically healthy children, starting in primary and mixed dentition. Our aim is to synthesize the data (January 2014–April 2026) on LPP progression description in systemically healthy children aged 2–13 years; clinical and biological responses to available treatment strategies, focusing on disease progression pattern, treatment efficacy and factors influencing treatment outcomes; and correlating findings with a report of a 24-month follow-up of a female prepubertal Caucasian patient during the primary and early stages of mixed dentition. Methods: A total of 489 studies were found after deduplication for the selected period. Due to the eligibility criteria, 9 studies plus another 10 contextual publications were included. Additionally, a 24-month follow-up of a previous LPP case was correlated. Results: LPP displayed rapid tissular destruction in primary dentition with risks to transfers to mixed and permanent dentition. The systemic antibiotic treatment reduced tissue loss, enabling fast periodontal regeneration. LPP is rare but severe, with a continuous biological trajectory, and with the window of opportunity remaining when the first symptoms appear. A few months (4–6 months) delay in diagnosis leads to irreversible tooth loss even in young patients with high biological healing potential. Conclusions: Systemic antibiotic treatment is mandatory in LPP/C-MIP cases from the primary dentition phase but does not reset host susceptibility. The Amoxicillin/Augmentin–Metronidazole association is recommended, with caution regarding dosage (adverse reactions). Periodontal gains are radiologically and clinically proven, but rebounding is possible. Full article

Background: Effective root canal disinfection is essential for successful nonsurgical root canal treatment (RCT). Although sodium hypochlorite (NaOCl) remains the standard irrigant, it carries a risk of chemical tissue injury if extruded beyond the root canal system and may have limited penetration into anatomically complex regions. Underwater discharge plasma (UDP) generates reactive oxygen and nitrogen species (RONS) through high-frequency, high-voltage electrical discharge in aqueous media, and preclinical and in vitro studies have reported broad-spectrum antimicrobial activity. This study evaluated the clinical and radiographic outcomes of nonsurgical RCT performed using physiological saline-based UDP irrigation without NaOCl in a heterogeneous real-world clinical cohort. Methods: This single-center retrospective cohort study included 186 teeth from 134 patients treated with the PLAZEN RCT^® UDP device and physiological saline irrigation, without NaOCl. The median follow-up period was 16 months. Radiographic outcomes were assessed using the Periapical Index (PAI) system, and treatment success was evaluated according to prespecified Strict and Loose criteria incorporating both radiographic and clinical findings. Stratified analysis was performed according to preoperative PAI score: Group A (PAI 1–2) and Group B (PAI 3–5). UDP-related adverse events, defined as thermal tissue injury caused by discharge heat, were ascertained through retrospective review of clinical records, operative notes, and serial periapical radiographs. Results: Among the 186 treated teeth, radiographic outcomes were classified as Healed (85.5%), Healing (3.8%), and Unhealed (10.8%). Overall Strict and Loose success rates were 79.6% and 82.3%, respectively. Initial treatment showed numerically higher success rates than retreatment. In the stratified analysis, Group A showed an 84.1% success rate with 100% tooth survival, whereas Group B demonstrated Strict and Loose success rates of 68.5% and 83.3%, respectively. Exploratory multivariable analysis showed that periodontal pocket depth > 3 mm was the most consistent factor associated with lower odds of treatment success, whereas associations involving canal obliteration and higher preoperative PAI score were less stable across sensitivity analyses and should be interpreted with caution. No UDP-related adverse events were recorded during follow-up. Attrition sensitivity analyses were performed, and the outcome estimates should be interpreted with caution, given the retrospective design and substantial loss to follow-up. Conclusions: In this preliminary observational cohort, physiological saline-based UDP irrigation without NaOCl was associated with favorable observed periapical healing outcomes and no recorded UDP-related adverse events over a median follow-up of 16 months. However, loss to follow-up was substantial; when all 116 teeth lost to follow-up were classified as treatment failures, the worst-case Strict success rate decreased to 49.0%. Therefore, these findings should be interpreted as preliminary descriptive evidence of clinical feasibility rather than as evidence of comparative efficacy or definitive clinical safety. Adequately powered randomized controlled trials with concurrent NaOCl control arms and long-term follow-up are warranted to evaluate the comparative effectiveness, safety, and reproducibility of physiological saline-based UDP irrigation protocols. Full article

Dental diseases have long been taught and treated as separate entities: cariology, operative dentistry, endodontics, and periodontology, each working within its own boundaries. However, increasing biological and clinical evidence suggests that this classified view does not fully reflect how disease progresses in the mouth. Instead, dental disease should be understood as a continuum within the interconnected tooth–pulp–periodontium complex. This review provides current evidence showing how dental caries can serve as the starting point of a process that can progress through pulpitis and apical periodontitis and eventually affect surrounding periodontal tissues. Caries is now widely known as a biofilm-driven and host-influenced condition shaped by ecological imbalance rather than specific pathogens alone. As lesions penetrate deeper into dentin, the structure becomes more permeable, permitting diffusion of microbial metabolites and signaling molecules toward the pulp. This initiates a multifaceted inflammatory reaction within the pulp tissue. At this stage, pulpitis becomes a critical turning point, where the outcome depends on microbial load, lesion activity, host response, and quality of clinical intervention. If the disease is not well controlled, it may lead to pulp necrosis, allowing infection to spread beyond the root canal and initiate periapical inflammation. Through anatomical pathways such as apical foramina and lateral canals, these processes can extend further, sometimes resembling or overlapping with periodontal disease. This overlap creates diagnostic challenges, as conventional tests may not always distinguish between conditions. A structured, pathway-based diagnostic approach is therefore essential. From a treatment perspective, this continuum model highlights early intervention, minimally invasive care, preservation of pulp vitality when possible, and maintenance of a strong coronal seal. Ultimately, stronger integration across dental disciplines can improve diagnosis, guide treatment decisions, support long-term tooth preservation, and promote unified dental education. This article presents a narrative review supported by a structured literature search and proposes a clinically actionable framework that extends established endodontic–periodontal concepts upstream to include caries initiation and restorative modulation. Full article

Diabetes mellitus (DM) fundamentally disrupts the oral microbiome, initiating a dysbiotic shift that drives progressive periodontal tissue breakdown. This transition is mediated by complex, bidirectional immune crosstalk, primarily centering on the upregulation of the Th17/Interleukin-17 (IL-17) inflammatory pathway. This systematic review and meta-analysis quantified the specific impact of this diabetic microbiota on immune activation and periodontal destruction. A comprehensive search of PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library was conducted for studies published up to 2026. Eligible studies included assessing oral/salivary microbiome shifts and their localized or systemic immunological consequences in diabetic periodontitis. A random-effects meta-analysis synthesized standardized mean differences (Hedges’ g) to evaluate the magnitude of these effects. Quantitative synthesis of preclinical data (four studies yielding eight discrete comparisons) revealed that exposure to a diabetic/dysbiotic microbiota significantly increased overall immune activation and periodontal inflammation relative to eubiotic controls (pooled Hedges’ g = 3.73, 95% CI 2.96–4.51). Subgroup analyses confirmed profound, statistically significant effects specifically on the Th17/IL-17 axis (g = 4.03) and periodontal bone destruction pathways (g = 3.37). Preclinical murine data suggests diabetes-associated oral dysbiosis may contribute to periodontal destruction by upregulating the Th17/IL-17 immune axis. However, direct extrapolation to humans is restricted, necessitating further clinical studies to validate these findings. 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

Orthodontic tooth movement (OTM) is a biologically driven process resulting from the mechanically induced remodeling of the periodontal ligament (PDL) and alveolar bone. A marked inter-individual variability exists in the rate of tooth movement, susceptibility to adverse outcomes such as external apical root resorption (EARR), and overall treatment response. This narrative review synthesizes current evidence on molecular, genetic, and epigenetic biomarkers that underline these differences. We summarize established local biomarkers derived from gingival crevicular fluid and saliva, including inflammatory cytokines, matrix metalloproteinases, and bone remodeling mediators reflecting OTM compression- and tension-side biology. Beyond fluid biomarkers, growing attention is given to genetic and epigenetic determinants of OTM. Specific gene mutations are associated with impaired or absent tooth movement, while multiple single-nucleotide polymorphisms have been linked to increased risk of EARR. Recent studies further demonstrate that orthodontic forces induce epigenetic remodeling in PDL cells, including DNA methylation changes in the gene promoters, histone modifications, and force-responsive non-coding RNAs such as miR-21 and miR-146a, which collectively regulate osteoclastogenesis, inflammation, and tissue adaptation. These findings indicate that OTM is governed by an integrated network combining mechanical stimuli with genetic predisposition and dynamic epigenetic regulation. Understanding these mechanisms provides a foundation for the development of biomarker-guided, patient-specific therapeutic strategies. Full article

Background/Objectives: Endodontic perforation repair requires biomaterials that balance sealing ability with minimal cellular injury. AH Plus (epoxy resin-based) remains widely used despite cytotoxicity concerns. CeraSeal (calcium silicate-based bioceramic) is a potentially more biocompatible alternative. However, comparative data on sealer-induced cytotoxicity and inflammatory responses remain limited. This study compared the cytotoxicity and inflammatory profiles of CeraSeal and AH Plus using in vitro and in vivo approaches. Methods: Human periodontal ligament stem cells (hPDLSCs) were exposed to sealer extracts (1:4 AH Plus, 1:8 CeraSeal) for 120 h. Cell death was assessed by MTT, Live/Dead, LDH release, and Annexin V/PI flow cytometry. Oxidative stress was quantified via ROS generation (DCFH-DA). In a rat furcation perforation model (n = 8 teeth/group), inflammatory markers (TNF-α, IL-1β, CD68), osteogenic activity (ALP), and osteoclasts (TRAP) were evaluated. Results: AH Plus was associated with significantly greater necrotic cell death (357.6 ± 47.6% LDH release vs. CeraSeal 128.8 ± 37.5%; p = 0.0079) and reduced hPDLSC viability at all time points (p < 0.0001). ROS generation was comparable between sealers (~32–35%, p > 0.05). In vivo, IL-1β was higher in AH Plus-treated tissues (52.25 vs. 24.88 cells/mm²; p = 0.0002), while TNF-α and CD68 were greater in CeraSeal (p ≤ 0.0011). ALP was higher in AH Plus (median 6.15 vs. 3.68; p = 0.0002), with no difference in TRAP-positive osteoclasts. Morphometric analysis showed superior cellular preservation with CeraSeal (p = 0.0079), while inflammatory infiltration was higher in CeraSeal (p = 0.0002). Conclusions: AH Plus was associated with a necrotic-inflammatory profile with elevated IL-1β and higher ALP expression. CeraSeal demonstrated better cellular preservation, lower LDH release, and a distinct inflammatory signature (higher TNF-α and CD68). These findings establish comparative response profiles for the two sealers and support CeraSeal as a potentially biocompatible alternative, though further mechanistic studies are warranted. Full article

Periodontal disease remains one of the leading causes of tooth loss worldwide, highlighting the need for effective regeneration of alveolar bone, periodontal ligament, and cementum. The structural complexity and unique biological behavior of these tissues have historically posed significant challenges for clinical regeneration strategies. The primary therapeutic approach used is guided bone regeneration; however, it has certain limitations, such as morbidity, low structural integrity and dimensional stability. Recent advances in 3-dimensional (3D) bioprinting have made it possible to fabricate customized scaffolds with precise architecture and spatial organization that closely mimic normal periodontal structures. The incorporation of multifunctional nanocomposite biomaterials and nanoparticles further enhances the performance of the scaffolds by increasing mechanical strength, bioactivity and controlling degradation rates. These advanced scaffolds function as dynamic microenvironments that support cell adhesion, proliferation and differentiation, ultimately promoting tissue regeneration. Furthermore, their multifunctional properties allow for the controlled release of growth factors, anti-inflammatory and antimicrobial agents, as well as the incorporation of stem cells and bioactive molecules that facilitate angiogenesis. This review investigates and critically evaluates modern approaches for the regeneration of periodontal tissues through scaffolds, biomaterials and 3D bioprinting technologies, as well as to assess their effectiveness compared to established clinical practices. Full article

Background and Objectives: Warm injectable gutta-percha techniques may improve three-dimensional filling of complex canal anatomy, but heat transfer to the external root surface may threaten periodontal tissues when the 47 °C threshold is exceeded. This in vitro study quantified external root-surface temperature changes during obturation with the Woodpecker FI-G/FI-P system and compared manufacturer preset temperatures with actual device output. Materials and Methods: Twenty extracted single-rooted human teeth standardized to 18 mm were prepared and assigned to obturation at 180 °C (Group A, n = 10) or 230 °C (Group B, n = 10). Infrared thermography recorded coronal, middle, and apical root-surface temperatures. A second device-based experiment measured FI-G and FI-P output at preset temperatures of 150 °C, 180 °C, 200 °C, and 230 °C. Results: The 230 °C setting produced significantly higher middle-third temperatures than the 180 °C setting (41.84 ± 5.52 °C vs. 36.99 ± 3.21 °C; p = 0.027; Cohen’s d = 1.07), whereas coronal and apical differences were not significant. The highest external root-surface value was 49.6 °C, and 3/10 specimens obturated at 230 °C exceeded 47 °C in the middle third. A significant coronal-to-middle gradient reversal was observed at 230 °C (p = 0.045). Device measurements showed strong attenuation between preset and output temperatures: at 230 °C, the FI-G tip base reached 150.0 °C but the tip apex reached 51.3 °C, while FI-P plugger tips reached 120.0 °C. Conclusions: The 180 °C setting produced a more predictable thermal profile, whereas 230 °C increased localized middle-third overheating risk. These in vitro findings support cautious temperature selection, especially in teeth with reduced dentin thickness or compromised root anatomy. Full article

Salivary aldehyde dehydrogenases (ALDHs), particularly ALDH3A1, are increasingly recognized as potential contributors to oral defense against aldehyde-associated stress at the oral–environment interface. Unlike freely secreted salivary enzymes, measurable salivary ALDH activity primarily reflects intracellular and vesicle-associated enzymes derived from salivary gland epithelial cells, oral mucosal cells, immune cells, and exfoliated cellular components. Within the oral exposome, ALDHs expressed in oral epithelial and salivary gland tissues participate in the detoxification of reactive aldehydes, while salivary ALDH activity may serve as an indicator of local aldehyde-detoxification capacity and tissue redox status. Beyond aldehyde metabolism, emerging evidence suggests that ALDH-associated pathways are linked to redox regulation, epithelial stress adaptation, inflammatory signaling, and tissue repair through NAD(P)⁺-dependent processes and stress-responsive networks such as Nrf2 and SIRT1. This review provides a saliva-focused synthesis of ALDH biology, emphasizing isoform-specific functions and the potential importance of ALDH3A1 in oral epithelial defense. Altered salivary ALDH activity has been reported in association with oral conditions including periodontitis, oral lichen planus, radiation-induced salivary dysfunction, and oral squamous cell carcinoma (OSCC). Genetic factors, particularly ALDH2 polymorphisms, together with environmental exposures and microbial dysbiosis, may further influence aldehyde burden and oral disease susceptibility. Although current evidence supports the biological relevance of salivary ALDHs, their utility as clinical biomarkers or therapeutic targets remains investigational and requires further mechanistic and clinical validation. 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

Magnesium-based membranes are promising biomaterials for guided bone regeneration due to their unique properties of mechanical strength, biocompatibility, and controlled biodegradation. This scoping review aimed to map and synthesize the available evidence regarding the use of magnesium-based membranes and fixation screws in alveolar ridge regeneration and guided bone regeneration procedures. Relevant studies were identified through a literature search conducted from November 2025 to May 2026, using several databases following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. Thirty-nine studies met the inclusion criteria, including in vitro studies, preclinical animal studies, clinical case reports and case series, and narrative or systematic reviews. In vitro studies demonstrated cytocompatibility and fibroblast adhesion, while moderate magnesium ion concentrations increased markers of osteogenic differentiation. Preclinical animal studies reported controlled degradation, biocompatible tissue responses, maintenance of barrier function during early healing, and findings suggesting potential osteogenic stimulation. Clinical evidence, limited to case reports and small case series, described the use of magnesium membranes in horizontal and vertical ridge augmentation, sinus lift procedures, immediate dentoalveolar regeneration, periodontal defects, and cystic lesions, with generally uneventful healing outcomes and preserved bone volume. Reported complications were mainly minor and included transient soft tissue reactions, membrane exposure, and localized gas cavity formation. However, the available evidence remains limited to low-level studies without controlled clinical trials. Current findings are insufficient to establish clinical efficacy or superiority over conventional membranes, highlighting the need for larger prospective controlled studies. The review’s findings could help researchers advance the understanding of bone regeneration and help develop new strategies to improve and further investigate bone regeneration. Full article

Recent advances in three-dimensional (3D)-bioprinted hydrogels show promise for overcoming the limitations of conventional techniques for dental tissue regeneration. This scoping review systematically analyses the physical, mechanical, and rheological properties of these hydrogels in dental applications, aiming to identify knowledge gaps, limitations, and current and future directions for advancing and translating hydrogel-based 3D bioprinting in dentistry. In accordance with PRISMA-ScR guidelines, a comprehensive literature search was conducted across Ovid, PubMed, EBSCOhost, and Web of Science up to January 2026. Included studies focused on (i) 3D-bioprinted hydrogels, (ii) quantitative characterisation, and (iii) dental tissue engineering. A total of twenty-one studies met the inclusion criteria. The findings revealed substantial variability in formulations and properties. Gelatine-based hydrogels reinforced with β-tricalcium phosphate demonstrated the highest compressive strength within the range of cancellous bone, whereas GelMA/PEGDA composites exhibited tunable stiffness suitable for soft tissue applications. Extrusion-based bioprinting emerged as the predominant method, with photocrosslinking and ionic crosslinking as the primary gelation techniques. Biodegradation rates varied notably with composition and regenerative objectives. This review uniquely consolidates the physical, mechanical, and rheological evaluations of 3D-bioprinted hydrogels for dental applications. The review highlights critical gaps in methodological standardisation and validation, emphasising the importance of biomaterial selection to optimise scaffolds and regenerative outcomes in periodontal, bone, and pulp tissue engineering. Full article

GLP-1 receptor agonists (GLP-1RAs) are widely used in the treatment of type 2 diabetes and obesity and are increasingly relevant in periodontal and implant practice. This review covers mechanisms, preclinical and early human evidence, and practical periodontal considerations; the structured database search is conducted in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) and the International Committee of Medical Journal Editors (ICMJE) principles. Two pathways explain GLP-1RAs’ relevance: indirect effects from better glycemic control, weight loss, and reduced inflammation; and direct tissue effects involving GLP-1R signaling and the GLP-1/dipeptidyl peptidase-4 (DPP-4) axis. Preclinical studies show reduced inflammation, osteoclast activity, and alveolar bone loss, along with improved periodontal stem cell function under hyperglycemia or inflammation via Nuclear Factor-kappaB (NF-kappaB), Wingless-related integration site (Wnt)/beta-catenin, and Mitogen-Activated Protein Kinase (MAPK) pathways. Animal studies on implants and local delivery, including exendin-4 platforms, suggest osteometabolic benefits. Human data are limited and mostly observational, and confounders include metabolic status, smoking, medication, and nutrition. Oral side effects such as xerostomia and dehydration are also noted. At present, GLP-1RA therapy should be regarded as a contextual modifier of periodontal risk and healing capacity rather than as a stand-alone periodontal therapy. Full article

Bone loss in the maxillofacial region arises from multiple causes, including periodontal disease, trauma, surgical procedures, infection, congenital anomalies, and cancer. Traditional treatment relies on bone grafting, either alone or in combination with biomaterials. Advances in tissue engineering have introduced synthetic or natural scaffolds to mimic the mineralized bone matrix. Natural scaffolds offer excellent biocompatibility and similarity to native tissue but often lack sufficient mechanical strength and exhibit poor degradation rates. Synthetic scaffolds provide tunable porosity and mechanical stability; however, their biological inertness makes them poor sources of osteogenic signaling. A key factor in the success of any scaffold is its interaction with the host immune system. Upon implantation, the innate immune response is initiated, with neutrophils and macrophages being the first cells to contact the scaffold. Macrophage polarization toward proinflammatory (M1) or anti-inflammatory (M2) phenotypes determines whether the microenvironment favors inflammation or remodeling. The adaptive immune response also plays a critical role: T and B lymphocytes may promote tolerance and integration through Th2/Treg pathways and antibody-mediated regulation, or they may trigger chronic inflammation and rejection through Th1/Th17 activation. This review examines the natural and synthetic materials used for bone remodeling and their biological properties. It then outlines the sequence of immune events occurring from the moment a scaffold is implanted to its potential integration or failure. Finally, this study highlights the relevance of cellular models and in vitro assays for the early evaluation of immunogenicity and biocompatibility, which are essential for optimizing scaffold design and improving outcomes in maxillofacial bone regeneration. Full article