Search Results (1,598)

Background: Periodontitis is a chronic inflammatory disease characterized by progressive destruction of the tooth-supporting tissues and may substantially impair oral health-related quality of life (OHRQoL). Although the clinical consequences of periodontitis are well documented, the extent to which disease severity is associated with patient-reported outcomes remains insufficiently understood. This study aimed to evaluate the association between periodontitis severity and OHRQoL and to examine sociodemographic, behavioral, and systemic factors associated with poorer OHRQoL. Methods: A cross-sectional analytical study was conducted among 136 adult patients diagnosed with stage II or stage IV periodontitis at the Periodontology Clinic of Universidad Tecnológica de México (UNITEC). OHRQoL was assessed using the Oral Health Impact Profile for Periodontal Disease (OHIP-14-PD). Sociodemographic characteristics, smoking status, and diabetes mellitus were recorded using a structured questionnaire. Periodontal status was determined through standardized clinical and radiographic examinations. The internal consistency of the OHIP-14-PD was evaluated using Cronbach’s alpha coefficient. Bivariate analyses were performed using non-parametric tests. An exploratory, partially adjusted multivariable linear regression model including sex, marital status, diabetes mellitus, and periodontitis stage was also performed. Results: Stage IV periodontitis was more prevalent than stage II periodontitis (55% vs. 45%). The mean OHIP-14-PD score was 24.9 ± 13.7, and the instrument demonstrated excellent internal consistency (Cronbach’s α = 0.89). Patients with stage IV periodontitis had significantly higher OHIP-14-PD scores than those with stage II disease (30.1 ± 12.4 vs. 18.6 ± 12.6; p < 0.001), indicating poorer OHRQoL. In the bivariate analyses, poorer OHRQoL was also observed among current smokers, participants with diabetes mellitus, those with lower educational attainment, and those with lower socioeconomic status (p < 0.05). In the exploratory partially adjusted model, male sex (β = 4.2; 95% CI: 0.1–8.2; p = 0.042), diabetes mellitus (β = 6.5; 95% CI: 2.1–10.9; p = 0.004), and stage IV periodontitis (β = 4.6; 95% CI: 0.4–8.7; p = 0.031) were associated with higher OHIP-14-PD scores. Conclusions: In this single-center cross-sectional sample, patients with stage IV periodontitis reported higher OHIP-14-PD scores than those with stage II periodontitis. These findings indicate an association within the studied clinical population and should not be interpreted as evidence of a causal effect or as directly generalizable to broader populations. Larger multicenter longitudinal studies including patients across all periodontitis stages are required to confirm the magnitude and external validity of this association. Full article

Background/Objectives: Surgical indications for spondylodiscitis are controversial, particularly when epidural extension and evolving neurological compromise are present. This study aimed to describe the clinical, neurological, pain-related, and inflammatory outcomes of patients with spondylodiscitis treated with decompressive laminectomy without spinal stabilization, at a single tertiary center. Methods: We retrospectively reviewed 15 consecutive patients with spondylodiscitis who underwent decompressive laminectomy at the University Hospital of Trieste between January 2017 and December 2023. Inclusion required at least 6 months of clinical and laboratory follow-up. Patients treated with acute vertebral stabilization were excluded. Collected data included spinal level, timing from diagnosis to surgery, visual analog scale (VAS) pain score, Cooper Scale grade, modified Japanese Orthopedic Association score (mJOA), white blood cell count, and C-reactive protein (CRP). Assessments were performed preoperatively (T0), 1 week after surgery (T1), and at 6 months (T2). Imaging findings from representative cases were reviewed to illustrate the radiographic evolution after decompression combined with antibiotic therapy and orthotic support. Results: The cohort included 8 women and 7 men with a mean age of 57.33 years. Twelve patients (80%) underwent surgery within 48 h because of neurological deterioration or urgent compressive findings. Thoracic involvement was predominant (11 cases, 73%), whereas cervical and lumbar disease accounted for 1 and 3 cases, respectively. Intraoperative cultures were positive in 9 patients (60%), and Staphylococcus aureus was isolated in 7 of these 9 cases (77.8%). Mean VAS pain score improved from 6.3 at T0 to 4.3 at T1 and 1.4 at T2. Mean lower-extremity Cooper Scale grade improved from 2.7 to 2.1 to 0.6; mean upper-extremity Cooper Scale grade improved from 1.3 to 1.0 to 0. Mean mJOA improved from 10.3 to 11.4 to 16.0. Mean white blood cell count declined from 11.58 to 8.35 to 6.14 × 10³/µL, and mean CRP declined from 123.9 to 72.81 to 19.44 mg/L. No patient worsened neurologically after surgery. No patient required acute stabilization or delayed arthrodesis during follow-up. Conclusions: In our case series of patients with compressive or progressive neurological spondylodiscitis, decompressive laminectomy combined with antibiotic treatment, bracing, and rehabilitation was associated with early neurological stabilization, substantial pain relief, and marked reduction in inflammatory markers, without subsequent need for instrumented stabilization. These data support the role of spinal decompression as part of a personalized, effective treatment strategy in patients with neurological decline. Full article

Background/Objectives: Humeral head osteonecrosis is a recognised complication of locked plate fixation for proximal humeral fractures, yet the significance of necrotic lesion extent is poorly characterised. This study quantified MRI-defined osteonecrosis extent and its associations with radiographic severity, shoulder motion, and functional outcomes. Methods: Twenty-five patients with Neer three- or four-part proximal humeral fractures treated by locked plate fixation between 2010 and 2022 were retrospectively reviewed. Shoulder range of motion, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and visual analogue scale (VAS) pain were assessed. Osteonecrosis severity was graded by the Cruess classification. Necrotic extent was quantified on MRI using an angle-based method on coronal and sagittal images; associations were assessed by simple linear regression among patients with confirmed osteonecrosis (n = 12). Results: At a mean follow-up of 85.4 ± 34.1 months, osteonecrosis was present in 12 of 25 patients (48%). Affected patients had lower shoulder abduction (96.7 ± 27.1° vs. 121.8 ± 29.2°; mean difference −25.1°, 95% CI −47.9 to −2.3; p = 0.031), internal rotation (48.3 ± 15.9° vs. 66.4 ± 15.5°; mean difference −18.1°, 95% CI −32.1 to −4.1; p = 0.014), and external rotation (36.7 ± 16.7° vs. 51.8 ± 26.4°; mean difference −15.1°, 95% CI −29.5 to −0.7; p = 0.041). Functional scores did not differ. Among patients with osteonecrosis (n = 12), greater necrotic angle correlated with higher Cruess stage and reduced abduction (β = −0.141; 95% CI −0.259 to −0.024; p = 0.020). Conclusions: MRI-defined osteonecrosis extent correlates with radiographic severity and reduced shoulder motion after locked plate fixation. Larger necrotic lesions are linked to decreased abduction, with no clear relationship to global functional scores. Quantitative MRI may provide useful information on the structural severity of post-traumatic humeral head osteonecrosis. Full article

Background/Objectives: We aimed to evaluate the methodological quality, translational limitations, and clinical applicability of current artificial intelligence (AI) applications in periodontology and to propose a framework for validated prediction and decision support. Methods: A structured narrative review based on a targeted, non-systematic literature search was conducted using PubMed and cross-disciplinary sources (January 2015–April 2026). Evidence from primary studies, systematic reviews, and methodological guidance for AI prediction models and clinical decision-support systems was synthesized with a focus on clinical applicability. Results: Current periodontal AI research is dominated by retrospective studies focusing on radiographic phenotyping, where deep learning models demonstrate promising diagnostic performance for detecting and quantifying periodontal bone loss. However, substantial limitations persist, including heterogeneous endpoints, inconsistent reporting, limited external validation, and insufficient calibration assessment. Importantly, there is little evidence that AI-based tools improve clinical decision-making or patient-relevant outcomes. Emerging work on prognostic modeling and multimodal data integration highlights the potential for individualized periodontal risk prediction but remains undervalidated, with limited evidence for clinical implementation. Conclusions: Although AI-based models show promising diagnostic performance, translational progress in periodontology is currently limited by insufficient validation and the lack of evidence for clinical utility. Future research should prioritize clinically actionable prediction models, robust external validation, and prospective evaluation of AI-supported decision-making within real-world periodontal care pathways. Full article

Isolated cortical vein thrombosis is a rare subtype of cerebral venous thrombosis with highly variable clinical and radiologic manifestations that frequently delay diagnosis. Bilateral thrombosis of the veins of Trolard is exceptionally uncommon, with only a few cases reported in the literature. We report a 64-year-old right-handed man who presented after being found unresponsive with suspected seizure. Although his neurological examination was normal at evaluation (NIHSS 0), noncontrast CT demonstrated subtle bilateral cortical vein hyperdensities (cord sign). Subsequent MRI and MR venography confirmed bilateral thrombosis of the veins of Trolard with associated venous congestion and a small sulcal subarachnoid hemorrhage. The patient was treated with therapeutic anticoagulation and levetiracetam. The patient achieved an excellent functional outcome (modified Rankin Scale score of 0). At 3-month follow-up, he remained neurologically intact without recurrent seizures. Follow-up MRI demonstrated improvement of the cortical FLAIR abnormality, and MR venography showed significant interval improvement in the bilateral vein of Trolard thromboses with residual short-segment nonocclusive filling defects, consistent with partial venous recanalization. This case expands the recognized clinical spectrum of the bilateral vein of Trolard thrombosis by demonstrating that extensive bilateral cortical venous involvement may present predominantly with seizure despite a normal neurological examination (NIHSS 0). Early recognition of subtle CT findings, confirmation with dedicated venous imaging, and prompt anticoagulation can result in excellent clinical recovery and favorable radiographic evolution. Full article

Background/Objectives: This study aimed to compare the incidence, extent, and time to diagnosis of osteonecrosis of the femoral head (ONFH) between Femoral Neck System (FNS) and multiple cannulated screw (CS) fixation in patients with femoral neck fractures (FNFs) at a minimum follow-up of 24 months, as well as to identify factors associated with ONFH after FNS fixation. Methods: A retrospective cohort study was conducted at a single university hospital involving patients aged ≥18 years with isolated FNFs treated by closed reduction and internal fixation using either FNS or multiple CS. Reduction quality, fracture union, incidence and extent of ONFH (measured by Kerboul angle), and revision surgery due to ONFH or other causes were assessed as outcome measures. Logistic regression analyses were conducted to identify factors associated with ONFH after FNS fixation. Results: Eighty-seven patients were included, comprising 48 in the FNS group and 39 in the CS group. No significant differences were found between the groups in reduction quality, union rate, or time to union (p > 0.05 for all). The incidence of ONFH did not differ significantly between the FNS and CS groups (p = 0.314). However, the FNS group showed a significantly greater extent of ONFH (p = 0.031) and longer mean time to ONFH diagnosis (p = 0.001). No significant differences were observed in revision surgery rates due to ONFH (p = 1.000) or other causes (p = 0.624). Multivariate analysis identified fracture displacement (Garden classification stages III and IV) and poor reduction quality (“Broken S” by Lowell’s criteria) as significant predictors of ONFH after FNS fixation. Conclusions: ONFH following FNS fixation tended to exhibit a larger necrotic area and a delayed radiographic onset compared to CS fixation; however, the overall incidence and revision rates were comparable between implants. These differences may be due to initial fracture displacement and baseline severity, rather than the FNS implant itself. In the FNS group, the mean time to radiographic diagnosis of ONFH was 13.1 months, and initial fracture displacement and reduction quality were identified as risk factors for the development of ONFH following FNS fixation. Therefore, long-term and vigilant follow-up is essential after FNS fixation, particularly in patients with displaced fractures. Achieving optimal reduction quality and anatomical femoral neck alignment remains paramount to mitigating the risk of ONFH after FNS fixation. Full article

Background/Objectives: This retrospective cephalometric study evaluated skeletal, alveolar, and dentoalveolar changes following alternate rapid maxillary expansion and constriction using a two-hinged maxillary expander (Alt-RAMEC/2-HME) and rapid maxillary expansion with facemask therapy (RME/FM) in skeletal Class III patients with maxillary retrusion, using a Le Fort I osteotomy group as a surgical reference. Methods: Pre-treatment (T0) and post-treatment (T1) lateral cephalometric radiographs of 42 patients were analyzed. Patients were divided into three groups—Alt-RAMEC/2-HME (n = 14), RME/FM (n = 14), and Le Fort I osteotomy (n = 14)—representing late-growth adolescents, growing children, and mature adults, respectively. Sagittal and vertical landmark positions were measured using a Cartesian coordinate system. The primary outcome was sagittal A-point displacement between T0 and T1. Intergroup changes were compared using non-parametric tests (p < 0.05). Results: Sagittal A-point displacement increased significantly in all groups. A larger A-point displacement was observed in the Le Fort I osteotomy group than in the two orthopedic groups (p < 0.001), whereas no significant difference was observed between the Alt-RAMEC/2-HME and RME/FM groups. Greater dentoalveolar positional changes were observed in the RME/FM group, in the maxillary incisor and molar regions. Conclusions: Sagittal A-point displacement was observed following Alt-RAMEC/2-HME in late-growth skeletal Class III patients with maxillary retrusion. However, in the absence of an untreated age- and skeletal maturity-matched control group, the observed displacement cannot be distinguished definitively from the normal craniofacial growth trajectory. These findings should also be interpreted in light of the retrospective study design and baseline differences between groups. Full article

Background/Objectives: Platelet-rich fibrin (PRF) and its derivatives have been proposed as biological adjuncts to enhance tissue healing following endodontic microsurgery (EMS). However, current evidence regarding their effects on postoperative recovery and long-term bone regeneration remains inconsistent. This study aimed to evaluate the efficacy of PRF and its derivatives as adjuncts in endodontic microsurgery by separately assessing patient-centered postoperative outcomes and radiographic and volumetric bone-healing outcomes through a systematic review and meta-analysis. Methods: This systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420261400163). Randomized controlled trials and comparative clinical studies evaluating PRF or its derivatives as adjuncts to EMS were eligible. MEDLINE/PubMed, Embase, Scopus, Web of Science, Cochrane CENTRAL, and reference lists were searched from inception to April 2026. Outcomes included postoperative pain, edema, quality of life, clinical–radiographic healing, CBCT volumetric bone regeneration, bone density, and outcomes in complex defects. Risk of bias was assessed using RoB 2 and ROBINS-I. Random-effects meta-analyses were performed where appropriate, and certainty of evidence was evaluated using the GRADE approach. Results: Seventeen clinical reports corresponding to sixteen independent datasets were included. PRF and its derivatives improved early postoperative recovery, particularly postoperative pain during the first postoperative week. Meta-analysis demonstrated a significant reduction in early postoperative pain favoring PRF-based interventions (SMD/Hedges g = −0.62; 95% CI, −1.03 to −0.21; p = 0.003). Evidence regarding long-term bone regeneration and clinical–radiographic healing remained heterogeneous and inconclusive. CBCT-based studies suggested accelerated early bone healing, although no consistent superiority was demonstrated at 6–12 months. The certainty of evidence ranged from moderate for postoperative pain to very low for volumetric bone regeneration. Interpretation of the findings is limited by clinical and methodological heterogeneity and the small number of studies available for several outcomes. Conclusions: The available evidence suggests that PRF may improve early postoperative recovery and soft-tissue healing after endodontic microsurgery. However, current evidence does not support PRF as a predictable substitute for bone grafts or regenerative biomaterials in large or non-contained defects. Well-designed CBCT-based randomized clinical trials with standardized outcome measures are needed. Full article

Background/Objectives: Calcium-silicate-based materials, many of which are commonly classified as bioceramics, are increasingly used for pulpotomy in vital primary teeth. This umbrella review synthesized systematic reviews and meta-analyses evaluating their clinical and radiographic outcomes. Methods: Eligible reports were systematic reviews of human primary-tooth pulpotomy involving calcium-silicate-based materials and reporting clinical and/or radiographic outcomes. MEDLINE/PubMed, Embase, and Scopus were searched from inception through June 2026. Methodological quality was appraised using AMSTAR-2, overlap was quantified using the Corrected Covered Area (CCA), and certainty was assessed using a GRADE-informed approach. Findings were integrated through structured narrative synthesis and review-level functional meta-synthesis. The protocol was registered in PROSPERO (CRD420261338396). Results: Eleven systematic reviews were included, comprising 78 unique primary-study reports and 180 study occurrences; aggregate participant totals were not calculated because of primary-study overlap. AMSTAR-2 confidence ranged from critically low to moderate, and overlap was high (CCA 13.1%). MTA and Biodentine showed broadly comparable clinical and radiographic outcomes through 24 months. Evidence for Biodentine versus formocresol was less consistent: one meta-analysis reported more favorable radiographic outcomes with Biodentine; whereas, another found no substantial difference; clinical superiority was not consistently demonstrated. Comparisons with ferric sulfate were generally inconclusive, and evidence for newer calcium-silicate-based formulations remained limited. No material demonstrated sustained long-term superiority. Certainty was predominantly low, with very low certainty for several sparsely studied comparisons. Conclusions: Contemporary calcium-silicate-based materials show high clinical and radiographic success in vital primary-tooth pulpotomy, but comparative conclusions remain constrained by methodological limitations, high overlap, and limited certainty. Full article

Background/Objectives: Aneurysmal subarachnoid hemorrhage (aSAH) carries high morbidity and mortality, with delayed cerebral ischemia (DCI) as a major secondary complication. Although infection has increasingly been implicated in DCI pathogenesis, the role of central nervous system (CNS) infection remains unclear. We evaluated CNS infection-related parameters for predicting DCI and functional outcome after aSAH using machine learning. Methods: This retrospective single-center study included 191 patients with confirmed aSAH treated in the intensive care unit between 2019 and 2024. Demographic, clinical, radiographic, treatment-related, microbiological, cerebrospinal fluid (CSF), and longitudinal laboratory data were extracted from electronic records. DCI was analyzed as a binary outcome, and discharge functional outcome was dichotomized using the modified Rankin Scale (0–2 vs. 3–6). Twelve feature selection methods and twelve classifiers were evaluated using five-fold cross-validation. Results: For DCI prediction, the models achieved a mean accuracy of 0.96, F1-score of 0.96, and AUC of 0.98. Key predictors included antibiotic therapy, aneurysm treatment modality, history of thrombosis, and EVD revision, along with mean albumin, red cell distribution width, INR, minimum aspartate aminotransferase, and CSF glucose, lactate, nucleated cell count, and cellular debris. For functional outcome prediction, accuracy was 0.948, F1-score 0.95, and AUC was 0.97. Predictors comprised cerebral vasospasm, number of spasmolysis procedures, pre-admission anticoagulation, CSF pathogen detection and type, aPTT, fibrinogen, aspartate aminotransferase, lactate dehydrogenase, and CSF mononuclear cell proportion, leukocyte count, and glucose concentration. Conclusions: Machine learning models integrating clinical, systemic, and CSF-derived parameters demonstrated excellent performance in predicting both DCI and functional outcome after aSAH. The identified predictors highlight the importance of the neurocritical care course, including infection-related and thromboinflammatory processes, and extend beyond traditional vasospasm-centered paradigms. These findings may inform risk stratification, although the temporal relationship between several predictors and outcome onset means the models should be regarded as hypothesis-generating rather than tools for early clinical prediction. Full article

Background/Objectives: The scapholunate interosseous ligament (SLIL) is a C-shaped structure composed of dorsal, proximal, and volar segments and is the primary stabilizer of the scapholunate joint. Injury leads to loss of wrist motion and altered carpal mechanics, and chronic laxity may produce radiocarpal and midcarpal degenerative change. Because isolated SLIL injuries frequently lack overt radiographic findings, delayed diagnosis allows progression to fixed carpal malalignment and arthritis, substantially narrowing later treatment options. Methods: A narrative review was conducted. PubMed, Embase, and Google Scholar were searched for English-language articles published between January 1974 and 2025 using combinations of the terms “scapholunate interosseous ligament,” “scapholunate instability,” “scapholunate dissociation,” “carpal instability,” “wrist arthroscopy,” and “scapholunate reconstruction.” Articles were selected for relevance to SLIL anatomy, biomechanics, injury, and treatment, and were appraised with attention to level of evidence. Results: The SLIL is compositionally heterogeneous, ranging from cartilage-like proximally to ligamentous dorsally, and is supported by dorsal and volar secondary stabilizers. Radiographs are frequently normal in partial and predynamic tears; MRI has limited sensitivity for partial tears, arthrography improves accuracy, and arthroscopy remains the diagnostic gold standard. Management is stage-dependent: non-operative care for occult and predynamic instability, direct repair with dorsal capsulodesis for acute reducible injuries, ligament reconstruction such as three-ligament tenodesis for chronic reducible injuries, and salvage procedures for scapholunate advanced collapse. Reported outcomes are favorable but variable, and no reconstructive technique demonstrates consistent superiority. Nearly all outcome data derive from retrospective series with heterogeneous outcome measures. Conclusions: Early recognition and stage-appropriate treatment selection are central to optimizing outcomes in SLIL injury. Current recommendations rest largely on low-level, heterogeneous evidence, and prospective multicenter comparative studies using validated patient-reported and radiographic outcomes represent the field’s most important unmet need. Full article

Background: Posterior spinal fusion (PSF) provides reliable deformity correction for adolescent idiopathic scoliosis (AIS); however, it reduces lumbar mobility because of the fusion of motion segments. Hybrid fixation, which combines thoracic PSF with thoracolumbar/lumbar vertebral body tethering (VBT), aims to preserve lumbar function while maintaining satisfactory deformity correction. Methods: This retrospective, non-randomized comparative cohort study included 66 adolescents with double-major AIS treated with hybrid fixation (n = 30) or posterior long fusion (n = 36) at a single tertiary referral spine deformity center. Radiographic outcomes, lumbar flexibility, sagittal range of motion (ROM), lumbar core muscle strength (LCMS), SRS-22r Function scores, complications, and revision surgery were assessed after a minimum follow-up of 24 months. Multivariable regression analyses were used to identify independent predictors of postoperative functional outcomes. Results: Both procedures achieved excellent correction of the main thoracic curve and satisfactory global spinal alignment. Posterior long fusion provided greater thoracolumbar/lumbar curve correction (p < 0.001), whereas hybrid fixation resulted in significantly better lumbar flexibility, sagittal ROM, and LCMS (all p ≤ 0.006). Radiographic tether breakage occurred in eight hybrid patients (26.7%), though most were asymptomatic; revision surgery was required in two patients (6.7% vs. 0%, p = 0.20). Conclusions: Hybrid fixation was associated with better objective lumbar function than posterior long fusion, with satisfactory deformity correction, in adolescents with double-major AIS. This benefit should be weighed against a higher complication rate driven mainly by tether breakage, supporting individualized, shared decision-making for motion-preserving strategies. Full article

Background: Maxillary sinus floor elevation is a predictable procedure for implant rehabilitation in the posterior maxilla with reduced residual bone height. Schneiderian membrane perforation is the most frequent intraoperative complication during sinus lift surgery and may compromise graft stability and treatment outcomes. Stabilized collagen membrane techniques have been proposed to manage extensive perforations. Objective: The aim of this study was to describe the management of a large Schneiderian membrane perforation (>10 mm) using a stabilized collagen membrane technique and to evaluate the clinical outcome. Case Description: A 67-year-old male patient (ASA I, non-smoker) with insufficient posterior maxillary bone height underwent lateral window sinus augmentation. During membrane elevation, a large perforation (>10 mm) occurred. A resorbable collagen membrane was adapted and stabilized to isolate the defect and create a contained compartment for graft placement. A xenograft was inserted, and an additional collagen membrane was used to cover the lateral window and stabilized with fixation pins. Primary closure was achieved with tension-free sutures. Results: Healing was uneventful, without sinus pathology or postoperative complications. Radiographic evaluation confirmed graft stability and adequate volume maintenance. Implant placement was successfully performed after 6 months, achieving satisfactory primary stability and favorable clinical outcomes after one year of loading. Conclusion: In this case, the stabilized collagen membrane technique allowed successful management of a large Schneiderian membrane perforation, enabling continuation of sinus augmentation, successful graft containment, and favorable implant rehabilitation outcomes. Full article

Background: Vertical implant positioning may influence peri-implant health outcomes and long-term stability; however, the impact of baseline vertical implant positioning relative to adjacent teeth remains unclear. The aim of this systematic review and meta-analysis was to assess the association between baseline vertical implant positioning and peri-implant clinical and radiographic outcomes. Methods: The Cochrane Central Register, PubMed, SCOPUS, and Web of Science were searched. Vertical implant positioning relative to adjacent teeth was assessed using two radiographic reference distances: implant platform to cemento-enamel junction (IP–CEJ) and implant platform to adjacent interproximal alveolar bone level (IP–ABL). The primary outcome was peri-implant marginal bone loss (MBL). Secondary outcomes included implant survival and success rates, peri-implant mucositis and peri-implantitis prevalence. Risk of bias was assessed using the Moga checklist, and certainty of evidence was evaluated according to GRADE. Results: Four studies including 267 implants fulfilled the inclusion criteria. The pooled mean baseline IP–CEJ and IP–ABL distances were 4.69 mm (95% CI 2.05 to 7.32) and 2.13 mm (95% CI 1.29 to 2.98), respectively. The pooled mean marginal bone loss after at least 12 months, based on three studies, was 0.21 mm (95% CI −0.28 to 0.70). Conclusions: The available evidence is insufficient to determine whether baseline IP–CEJ or IP–ABL distances are associated with peri-implant outcomes or to identify an optimal range of vertical implant positioning. The findings should be interpreted cautiously because the certainty of evidence is very low, highlighting the need for prospective studies with long-term follow-up. Full article

Background/Objectives: One-stage revision has become an increasingly accepted strategy for the treatment of chronic periprosthetic joint infection (PJI) of the knee in carefully selected patients. The use of a resorbable defensive antibacterial coating (DAC^® hydrogel) represents an attractive adjunct to reduce bacterial adhesion and biofilm formation on revision implants. However, evidence regarding its long-term performance is limited. Methods: We retrospectively reviewed 52 consecutive patients undergoing one-stage revision for knee PJI or an infected spacer between 2014 and 2023 using a standardized surgical and antimicrobial protocol including local application of DAC hydrogel loaded with vancomycin alone or vancomycin plus meropenem. Clinical, microbiological, and radiographic outcomes were evaluated. Infection-free survival was assessed using Kaplan–Meier analysis. Results: Forty-eight patients underwent revision for PJI and four for septic spacers. Four patients were unavailable for final evaluation. At follow-up of 7.7 ± 2.9 years (range 2.5–12.2 years), 47 of 48 clinically evaluable patients remained infection-free, corresponding to a crude infection-free proportion of 97.9%. Kaplan–Meier infection-free survivorship at 12 years was 98.1% (95% CI, 87.1–99.7%). Mean Knee Society Score improved from 47.7 to 84.4 points, while functional KSS improved from 41.9 to 82.9 points. Pain at rest decreased from 6.9 to 0.7 and pain during movement from 8.1 to 1.6 on the visual analogue scale. Conclusions: This series represents, to our knowledge, the longest reported follow-up of one-stage knee revision using the DAC hydrogel coating. The favorable outcomes observed with this hybrid fixation strategy support further investigation of this approach in larger, long-term, comparative multicenter studies. Full article