PURPOSE:Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication that can arise in patients receiving antiresorptive or antiangiogenic therapy. Despite known predisposing factors, effective prophylaxis is currently little used. We therefore sought to assess the standardised prevention protocols that are used in our institution for reducing MRONJs among at-risk patients and to quantify the consistency of the effects. METHODS AND MATERIALS:This retrospective cohort study analysed 422 dental extraction records from 126 patients who had received antiresorptive or antiangiogenic therapy. The extractions were classified into four risk levels based on medication class, cumulative treatment duration, comorbidity burden and immunosuppression status. The effect of the prevention protocol was estimated using Mantel-Haenszel stratified analysis, with the risk level as the stratifying variable, and the homogeneity of the effect was assessed using the Breslow-Day test. RESULTS:MRONJ developed in 94.1% of extractions performed without prevention protocols and in only 6.7% with prophylactic protocols; Mantel-Haenszel stratified analysis - adjusting for the baseline risk level - produced a common OR of 0.0044 (95% CI: 0.0010-0.0195, p 0.0001). Stratum-specific estimates were consistent across all three risk levels, and the Breslow-Day test confirmed the homogeneity of the effect. CONCLUSIONS:Mantel-Haenszel stratified analysis confirmed consistent protective effects of the applied prevention protocols, with different proportionality, across every risk level. This study proposes the first stratified quantification of prevention protocol effectiveness across a validated composite risk scoring system.
PURPOSE:Inadequate oral hygiene and management affect oral health and are associated with systemic diseases. Although systemic disease history may relate to subjective oral status and oral health behaviours, these associations remain insufficiently examined. This study investigated the associations between systemic disease history, subjective oral status, and oral health behaviours among community-dwelling older adults. METHODS AND MATERIALS:We analysed data from 979 individuals aged 65-85 years, residing in Higashiura-cho, Aichi Prefecture, who participated in a 2018 group examination and completed a self-administered questionnaire. Multivariable logistic regression was used to evaluate associations between oral-related variables ('concerns about teeth and mouth condition', 'use of interdental brushes and dental floss', and 'experience of oral hygiene instruction') and histories of systemic diseases (cancer, myocardial infarction, stroke, hypertension, diabetes, liver disease, lung disease, mental illness, and bone disease). RESULTS:The mean age was 73.0 ± 5.2 years, and 52.4% were female. No significant associations were observed between 'concerns about teeth and mouth condition', 'use of interdental brushes and dental floss', and systemic disease history. However, participants who had received oral hygiene instruction had higher odds of a history of hypertension (odds ratio: 1.4; 95% confidence interval: 1.0-2.0). CONCLUSION:Among community-dwelling older adults, receiving oral hygiene instruction was positively associated with a history of hypertension. As the data were self-reported, findings should be interpreted with caution. Dental hygienists should consider patients' systemic health status, particularly hypertension, when providing oral hygiene instruction.
BACKGROUND:Gingival mast cells (MCs) are strategically scattered throughout connective tissue and adhere to the endothelium to convert local impulses into systemic signals and attract additional immune effector cells. Numerous mediators, such as histamine, cytokines, and proteases, modulate these interaction pathways. OBJECTIVES:The purpose of this study was to determine and compare MC count in the gingival enlargement tissue of patients receiving orthodontic treatment versus patients having plaque-induced gingival enlargement without orthodontic treatment, utilising hematoxylin and eosin (H&E) staining, toluidine blue (TB), and CD117 (c-kit) immunohistochemistry (IHC) as a specific marker for MC identification. METHODS AND MATERIALS:This study involved 30 patients who were divided into three groups: Group 1 included 10 patients with clinically healthy gingival tissue that intentionally needed crown lengthening. Group 2 included 10 cases of plaque-induced gingival enlargement in individuals without orthodontic treatment. Group 3 included 10 cases of orthodontic gingival enlargement in individuals receiving orthodontic treatment. Patients received non-surgical periodontal therapy and oral hygiene instructions. After the plaque control phase, with a Gingival Index (GI) = 0 and no Bleeding on Probing (BoP), the gingiva was surgically treated. During the surgical procedure, the excised gingival margin was collected for histological examination with H&E, TB special stain, and c-kit to count the MCs. RESULTS:The gingiva of patients in group 3 was characterised by more frequent epithelial changes (mild hyperplasia of the basal layer and spongiosis), a stronger degree of inflammation, including band-like inflammatory infiltrates and individual inflammatory cells, and a milder degree of fibrosis, compared to group 2. In addition, a significant increase in the number of MCs was observed in group 3 compared with groups 2 and 1. c-kit was a more specific marker for MCs than for TB. CONCLUSION:Orthodontic-induced gingival enlargement showed a significantly higher number of mast cells than plaque-induced gingival enlargement, and this involvement of MCs, particularly, may be associated with mast cell activation and degranulation. These findings may suggest an immunological role for MCs in the pathogenesis of orthodontically induced gingival enlargement.
PURPOSE:Artificial intelligence (AI)-assisted applications are increasingly used to obtain health-related information; however, concerns remain regarding the reliability of AI-generated responses and their influence on patient attitudes and decision-making. This study aimed to evaluate the use of AI-assisted applications among patients, their trust in AI-generated information, and the influence of these applications on oral-health-related decision-making. METHODS AND MATERIALS:This cross-sectional questionnaire-based study included 430 patients attending the Department of Periodontology. Participants completed a structured questionnaire evaluating AI-assisted application use, trust in AI-generated oral health information, and the effects of AI on oral-health-related attitudes. Categorical variables were presented as frequencies (n) and percentages (%). Associations between categorical variables were analysed using the chi-square test. Effect sizes were evaluated using Cramér's V coefficient. Statistical significance was set at p 0.05. RESULTS:A total of 430 participants completed the questionnaire, including 300 AI users. AI usage rates were generally similar across reasons for admission, although the highest usage was observed among individuals attending routine check-ups (18/19; 94.7%). In treatment-related decisions, most participants preferred dentists' opinions over AI-generated recommendations (80.8%; p 0.01). Trust was significantly associated with AI usage frequency (p 0.01), whereas education level was significantly associated with AI usage (p 0.001). Education level was also associated with willingness to consult AI-assisted programmes regarding dentist-created treatment plans (p = 0.033). CONCLUSION:AI-assisted applications have become an important part of health information-seeking behaviour, particularly among younger and more educated individuals. However, patients remain cautious about the reliability of AI-generated information and continue to prioritise professional dental expertise in treatment-related decisions.
OBJECTIVE:This randomised controlled trial compared a novel disposable dental protective device with traditional medical goggles regarding splatter interception, patient experience, and safety during tooth preparation. METHODS:Seventy patients were allocated to use either the novel device (experimental group, n = 35) or medical goggles (control, n = 35) during standardised tooth preparation without suction. The primary outcome was the weight of captured splatter. Secondary outcomes included the total patient-reported outcome score derived from a seven-item, five-point Likert questionnaire and facial pressure sensation assessed using a visual analogue scale (VAS). RESULTS:The experimental group captured significantly more splatter (1.23 ± 0.35 g) than the control group (0.76 ± 0.21 g, mean difference 0.47 g, 95% confidence interval 0.33 to 0.61, P 0.001). Patients rated the novel device significantly higher with regard to the total subjective score, material softness, hygiene, protection, comfort, and overall satisfaction (P 0.001), and reported lower facial pressure (VAS 1.80 ± 1.19 vs 4.50 ± 2.10, P 0.001). No serious adverse events occurred. CONCLUSION:The novel disposable device demonstrated superior splatter interception, better patient acceptance, and less facial pressure compared to medical goggles, showing promise for enhancing facial protection in dentistry.
PURPOSE:The relationship between serum 25-hydroxyvitamin D [25(OH)D] levels and dental caries in children remains controversial. This study aimed to investigate the relationship between current serum 25(OH)D levels and dental caries experience in children. MATERIALS AND METHODS:This cross-sectional study included children aged 3 to 15 years without systemic disease who presented to the Department of Pediatrics, Ordu University Training and Research Hospital, Ordu, Turkey, between November and December 2023. Serum 25(OH)D levels obtained from routine blood tests and intraoral examinations performed on the same day were evaluated retrospectively. Dental caries experience was assessed using dmft and DMFT indices according to World Health Organization (WHO) criteria. Statistical analyses were performed to evaluate the relationship between serum 25(OH)D levels and caries experience. RESULTS:A total of 326 children were included (172 girls, 52.8%; 154 boys, 47.2%). The mean serum 25(OH)D level was 50.08 ± 16.68 nmol/l, and the mean combined caries index (decayed, missing, and filled primary teeth [dmft] and decayed, missing, and filled permanent teeth [DMFT]) was 3.66 ± 3.44. No statistically significant relationship was observed between serum 25(OH)D levels and caries experience (P > 0.05). Girls had statistically significantly lower serum 25(OH)D levels than boys (46.03 ± 15.21 nmol/l vs. 54.63 ± 17.10 nmol/l, P 0.001). CONCLUSIONS:Within the limitations of this cross-sectional study, no statistically significantly relationship was found between current serum 25(OH)D levels and dental caries experience in children. Further longitudinal studies with comprehensive assessment of potential confounding factors are needed to better clarify this relationship.
PURPOSE:Calcium channel blockers (CCBs) are widely used in cardiovascular disease management; however, calcium channel blocker-induced gingival overgrowth remains an underrecognized adverse effect that may impair oral hygiene, exacerbate periodontal inflammation, cause functional and esthetic problems, and potentially affect adherence to cardiovascular therapy. This study aimed to evaluate cardiologists' knowledge, awareness, and clinical practices regarding DIGO and to explore factors influencing preventive behaviors. MATERIALS AND METHODS:This cross-sectional, survey-based study included 139 cardiologists in Türkiye. A structured 25-item questionnaire assessed demographics, oral health awareness, prescribing habits, and clinical practices. Descriptive statistics, chi-square tests, and multivariable binary logistic regression analyses were performed to identify predictors of preventive counseling and oral-focused history taking. RESULTS:A total of 139 cardiologists participated in the study. Of these, 74.8% were male, and the most common age group was 40-49 years (37.4%). Within the past year, 66.9% had undergone a dental examination, and 47.5% reported a history of periodontal treatment. Knowledge of DIGO pathogenesis was reported by 41.3% of participants, whereas 31.2% stated they had no knowledge. Only 22.3% of cardiologists reported providing preventive oral health advice, while 61.2% referred patients after complications developed. Multivariable analysis revealed that knowledge of DIGO mechanisms was inversely associated with preventive counseling (OR = 0.44, p = 0.004), whereas prior oral health training showed a non-significant but clinically relevant positive trend (OR = 2.24, p = 0.061). Similarly, knowledge-related variables were not positively associated with oral-focused anamnesis. CONCLUSION:Cardiologists' awareness of DIGO remains limited, and their preventive practices are inadequate. The findings reveal a critical knowledge-behavior gap, indicating that increased awareness does not necessarily translate into preventive clinical practice. Interventions targeting behavioral change and structured interdisciplinary collaboration are essential to improve early recognition and management of DIGO.
PURPOSE:This study aims to examine, in a sex-stratified manner, the associations of fat mass index (FMI), muscle mass index (MMI), and the muscle-to-fat ratio (MFR) with oral health as represented by periodontitis (PD), and to quantify the mediating role of systemic inflammatory and oxidative stress (OS) markers in these associations. MATERIALS AND METHODS:This research drew on cross-sectional data from the National Health and Nutrition Examination Survey (NHANES 2011-2014; n=3,553). Confounder-adjusted weighted logistic regression models determined sex-stratified associations. Restricted cubic spline (RCS) regression evaluated non-linear MFR-PD relationships. Mediation analysis quantified the contribution of OS markers. RESULTS:Among women, lower MFR was associated with a statistically significantly increased PD risk (OR=0.49, 95% CI:0.34-0.72, p=0.001). Higher FMI (OR=1.59, 95% CI:1.15-2.19, p=0.008) and MMI (OR=1.86, 95% CI:1.13-3.07, p=0.018) also conferred increased risk. No statistically significant associations were observed in men. Serum albumin mediated 15.1% (p= 0.040) of the association between MFR and PD, 27.9% (p= 0.040) of the association between MMI and PD, and 23.4% (p0.001) of the association between FMI and PD. Subgroup analyses revealed no statistically significant interaction effects (all p> 0.05). CONCLUSION:In women, a lower MFR is independently associated with higher PD prevalence, while higher FMI and MMI are also associated with elevated PD prevalence. Serum albumin partly explains these associations, suggesting that oxidative stress may be one of the pathways linking body composition imbalance to compromised oral health. No comparable associations were observed in men. For clinicians, MFR together with serum albumin may serve as accessible and low-cost markers for identifying women, particularly those in the peri-menopausal period, who could benefit from early periodontal screening and targeted nutritional or lifestyle interventions. Prospective cohort studies and interventional trials are warranted to confirm causality and to evaluate whether improving body composition translates into measurable benefits for oral health.
BACKGROUND:Periodontitis is a chronic multifactorial inflammatory condition resulting in the gradual breakdown of periodontal supporting structures. Although non-surgical periodontal therapy (NSPT) is the gold standard first therapeutic option, its effectiveness can be limited in moderate-to-severe cases, hence necessitating the application of adjunctive therapies. Platelet-rich fibrin (PRF) and enamel matrix derivative (EMD) are among the most extensively utilised regenerative biomaterials; nevertheless, direct comparative evidence related to their adjunctive advantage in NSPT is scarce. AIM:This split-mouth randomised clinical trial compared the clinical effectiveness of EMD versus PRF as adjunct biological modalities to scaling and root planing (SRP) in the non-surgical management of Stage II/III and Grade A/B periodontitis. METHODS AND MATERIALS:Fifteen participants meeting the eligibility criteria were included, with thirteen completing the trial. Each patient contributed two interproximal sites randomly allocated to either adjunctive EMD or PRF after full-mouth SRP. Before the placement of biomaterial, EMD sites were treated with ethylenediaminetetraacetic acid (EDTA), whereas PRF was prepared utilising the standard horizontal centrifugation approach. Periodontal probing depth (PD), gingival margin (GM) position, clinical attachment level (CAL), and bleeding on probing (BOP) were measured at baseline and 6-month follow-up. RESULTS:Both biomaterials yielded significant intra-group improvements. Mean PD scores were reduced by 1.1 ± 0.6 mm in the EMD group and 1.2 ± 0.7 mm in the PRF group. CAL gains were 1.1 ± 0.7 mm and 1.1 ± 0.8 mm for EMD and PRF, respectively. GM levels remained stable across groups, and BOP markedly decreased (EMD: 77% to 23%; PRF: 85% to 31%). Intergroup comparisons revealed no statistically significant differences for PD (p > 0.999), GM (P = 0.174), or CAL (P = 0.556). Moreover, frequency distribution analysis showed that 100% of deep sites (≥ 6 mm) in the EMD group and 90% in the PRF group were reduced to 6 mm at 6 months. CONCLUSION:Both EMD and PRF showed comparable clinical outcomes as adjunctive regenerative biomaterials in NSPT to manage moderate periodontal pockets. These outcomes support the versatility of clinicians in selecting either biological option based on practitioner and patient preference, availability, and cost, while opening avenues for future studies investigating their application in more complex periodontal cases.
OBJECTIVE:To assess the potential causal relationships of the oral microbiome with the risks of oral cancer, oropharyngeal cancer, and tongue cancer using two-sample Mendelian randomisation (MR) analysis, while distinguishing these from reverse causal effects of the cancers on microbial abundance. METHODS AND MATERIALS:Using single-nucleotide polymorphisms as instrumental variables, we applied the MR inverse-variance-weighted approach to evaluate the effects of the dorsal-tongue and salivary microbiomes on oral, oropharyngeal, and tongue cancers. Analyses were conducted with the R package TwoSampleMR, leveraging genome-wide association study (GWAS) summary statistics from CNGBdb, the FinnGen consortium, and other sources. Sensitivity, heterogeneity, and pleiotropy assessments were performed. Additionally, reverse MR sensitivity analyses were conducted to explore the possible causal influence of cancers on the oral microbiota. RESULTS:Using a single nucleotide polymorphism (SNP) significance threshold of p 5 × 10-6, our large-scale MR study revealed genetically supported causal relationships between microbial taxa derived from saliva and the tongue and the risk of oral, oropharyngeal, and tongue cancers. Integrating these results, we found that both 's Veillonella_rogosae_mgs_2008' and 's unclassified_mgs_1048' conferred a reduced risk of oropharyngeal and tongue cancers. Sensitivity analyses based on heterogeneity tests and pleiotropy evaluations further corroborated the robustness of our findings, lending additional credibility to the conclusions. CONCLUSION:This study leveraged large-scale publicly available genetic data and identified significant causal relationships between the oral microbiota and cancers of the oral cavity, oropharynx, and tongue. Reverse MR analyses indicated that oral and tongue cancers may in turn alter the abundance of specific oral microbes, suggesting a potential bidirectional causal loop. Future work should integrate metagenomic data to further validate these microbiota-cancer associations.
BACKGROUND:Nitrate levels and diabetes are important factors influencing the risk of periodontitis. This study intended to assess the combined impact of urinary nitrate levels and diabetes on periodontitis risk in the general population. METHODS:This cross-sectional study employed the data on individuals aged 30 and above from the 2009-2014 National Health and Nutrition Examination Survey (NHANES) database. The urinary nitrate levels were divided into three groups based on the tertiles (low, median, and high). A multivariate logistic regression model was used to investigate the relationship between urinary nitrate levels and the risk of stage III/IV periodontitis, with stratified analysis conducted according to diabetes. The multiplicative interaction between nitrate levels and diabetes on periodontitis risk was analysed using the likelihood ratio test. A restricted cubic splines curve was utilised to assess the non-linear association. RESULTS:Among the 3,292 included participants, 841 (19.28%) individuals had stage III/IV periodontitis, while 2,451 (80.72%) did not. Compared with median nitrate levels, high nitrate levels (odds ratio [OR] = 1.58, 95% confidence interval [CI]: 1.12 to 2.22]) were associated with higher odds of stage III/IV periodontitis, but no statistically significant association was observed between low nitrate levels and periodontitis risk (P > 0.05). Urinary nitrate levels and diabetes showed a multiplicative interaction on the risk of stage III/IV periodontitis (P = 0.020). Specifically, high urinary nitrate levels (OR = 1.68, 95% CI: 1.16 to 2.43) were correlated with a higher risk of periodontitis in non-diabetic individuals, whereas in diabetic individuals, low urinary nitrate levels (OR = 1.66, 95% CI: 1.07 to 2.58) were associated with a higher risk of periodontitis. Moreover, urinary nitrate levels exhibited a statistically significant nonlinear relationship with stage III/IV periodontitis risk in the general population. CONCLUSION:High nitrate levels and diabetes exhibit a multiplicative interaction on periodontitis risk. Clinicians may need to monitor both blood glucose and urinary nitrate levels to screen individuals at high risk of periodontitis.
PURPOSE:To determine the prevalence and associated factors of hypomineralisation of second primary molars (HSPM) in children aged between 3 and 5 years, in Aydın. METHODS AND MATERIALS:A total of 1035 children, aged between 3 and 5 years old, participated in the study from 16 randomly selected kindergartens across 5 districts of Aydın. HSPM findings were recorded using the modified EAPD MIH Decision Criteria Index. To determine the associated factors, a questionnaire consisting of questions about prenatal, perinatal, and postnatal factors was filled out by parents. Descriptive statistics and Pearson chi-square tests were used. RESULTS:The mean age was 4.66 ± 0.53 years; the prevalence of HSPM was 4.4% at the patient level and 2.31% at the tooth level. White, cream, yellow or brown demarcated opacities were the most common lesion type (69.79%); the most affected jaw was the mandible (71.87%), and the mean number of affected teeth among the children with HSPM was 2.17 ± 0.99. Considering the associated factors of HSPM, maternal febrile illnesses during pregnancy and children's febrile illnesses during perinatal and postnatal periods, along with nutritional supplement use, preterm birth, or breastfeeding duration, did not show statistical significance in HSPM development (p > 0.05). CONCLUSION:Results of this study showed that the prevalence of HSPM (4.4%) in Aydın was slightly lower than the worldwide prevalence (6.8%). HSPM had many possible causes; to more clearly determine the aetiology of HSPM, more research is needed.
PURPOSE:The goal of this study was to look at the link between smoking, drinking coffee, and salivary oxidative stress biomarkers malondialdehyde (MDA) and superoxide dismutase (SOD) as signs of oral health risk among university students in Aceh, Indonesia, and to see if they could be used as non-invasive screening tools in a clinical setting. METHODS AND MATERIALS:There were three groups of students: active smokers, passive smokers, and non-smokers. We used validated questionnaires (Cronbach's alpha = 0.872) to gather behavioural data. We collected unstimulated saliva in a controlled manner and then used enzyme-linked immunosorbent assay (ELISA) to analyse it. We also looked at the physicochemical properties of saliva. We used ANOVA, the Kruskal-Wallis test, and receiver operating characteristic (ROC) curve analysis to analyse the data. RESULTS:Smokers had much higher MDA levels (4.1 ± 0.05 nmol/ml) and much lower SOD levels (0.72 ± 0.010 U/ml) than non-smokers (2.5 ± 0.01 nmol/ml; 1.20 ± 0.012 U/ml; P 0.001). Drinking coffee by itself didn't have a direct effect on oxidative stress, but when combined with smoking, it made the oxidative imbalance much worse. ROC analysis showed that the tests were very good at diagnosing (AUC = 0.88 for MDA; 0.84 for SOD). CONCLUSION:Salivary MDA and SOD are reliable, non-invasive markers that can detect early oxidative stress-related risk. It is a good idea to add saliva-based screening and culturally appropriate prevention strategies to campus health services. These results show that salivary biomarkers are useful in clinical settings for preventive dentistry.
PURPOSE:Eating disorders such as bulimia and anorexia negatively impact on oral health due to repeated exposure to gastric acid, leading to dental erosion and deterioration of restorative materials. Resin-Modified Glass-Ionomer Cement (RMGIC), Giomers and glass hybrid may offer greater resistance in these adverse environments. This study aimed to compare the effect of simulated gastric acid on the surface properties of different fluoride-releasing composite materials. MATERIALS AND METHODS:An in-vitro experimental study was conducted using disks of RMGIC (Gold Label Light-Cured Universal Restorative; G1_GLLC), Giomer (Beautifil II; G2_BFII), and glass hybrid (EQUIA Forte Fil; G3_EF), prepared according to manufacturers' instructions. Surface roughness, fluoride release and solubility were evaluated before and after 18 h of immersion in simulated gastric acid. Additionally, surface morphology was analyzed by scanning electron microscopy (SEM). Data were analyzed with one-way ANOVA and Student's t-test (p 0.05). RESULTS:G1_GLLC exhibited the highest increase in surface roughness after immersion (0.38 ± 0.25 µm), while G2_BFII demonstrated lower changes in surface roughness (0.17 ± 0.16 µm) and the lowest fluoride release (0.001 ppm) and solubility (0.93%). G3_EF showed the highest solubility (5.50%), indicating greater susceptibility to acidic environments. CONCLUSION:The surface roughness, fluoride release, and solubility of all tested materials were affected by simulated gastric acid. Giomer (G2_BFII) proved to be a suitable alternative in a highly acidic oral environment, as it remains stable and releases fluoride under acidic conditions compared to RMGIC (G1_GLLC) and glass hybrid (G3_EF).
PURPOSE:This study evaluated the impact of gene polymorphisms in VDR and MMP3 on caries and the efficacy of genetic factors in a novel caries risk model. METHODS AND MATERIALS:After oral examination of male individuals (aged 20-44), a diagnosis was made according to the decayed, missing and filled teeth (DMFT) index: Group 1 'high caries risk' (DMFT ≥ 14); Group 2 'low caries risk' (DMFT ≤ 5) (n = 162). Participants' detailed anamneses were recorded. Periodontal indices, saliva buffering capacity/BC, salivary quantity of Streptococcus mutans/SM and Lactobacillus spp./LB were measured. After DNA isolation, genotyping of the MMP3 (rs679620) and VDR (rs731236) genes was conducted using real-time polymerase chain reaction (PCR). A stepwise regression analysis was conducted to evaluate the explanatory contributions of independent variables to DMFT variability. The results were considered significant at p 0.05. RESULTS:Significant differences were observed between the groups in terms of the plaque index, gingival index, probing depth, bleeding on probing, salivary flow rate, BC, salivary quantity of LB, frequency of consuming sugary foods/drinks, frequency of tooth brushing, and the use of preventive dental treatment (p 0.001). The MMP3 rs679620 polymorphism significantly affected caries risk (p 0.001), while the VDR polymorphism was not significant (p = 0.862). An explanatory regression model for caries experience, created by stepwise regression analysis, explained 61.1% of the DMFT. CONCLUSION:Adding genetic factors to the caries risk model may have a significant effect on the accuracy of the model.
PURPOSE:Resveratrol, a natural polyphenol with anti-inflammatory and antioxidant properties, has been proposed as an adjunctive agent in periodontal therapy. This systematic review aimed to evaluate the effectiveness of resveratrol in controlling periodontal inflammation and alveolar bone loss in preclinical and clinical studies. METHODS AND MATERIALS:A systematic review was conducted following PRISMA 2020 guidelines. Electronic databases (PubMed/MEDLINE, Cochrane Library, Lilacs, Wiley, ScienceDirect) were searched up to October 2025, complemented by manual searches of periodontal journals. Eligible studies included in vivo animal experiments and randomised clinical trials assessing the impact of resveratrol on periodontal outcomes. Three reviewers independently performed study screening, data extraction, and risk-of-bias assessment using SYRCLE and Cochrane tools. RESULTS:Twenty-two studies met the inclusion criteria, including 16 preclinical and 6 clinical studies. In animal models, resveratrol consistently reduced alveolar bone loss (7.09% to 60.60%) and improved inflammatory and oxidative stress markers. Clinical trials reported variable but generally positive effects, including reductions in probing pocket depth, bleeding index, and plaque index, and improvements in clinical attachment level. Several studies also showed decreased systemic or local inflammatory cytokines. Clinical evidence remains limited by small sample sizes, methodological heterogeneity, and short follow-up periods. No clinical study evaluated radiographic bone loss. CONCLUSION:Preclinical studies suggest that resveratrol has anti-inflammatory, antioxidant and bone-protective effects, but clinical evidence is limited and heterogeneous. Resveratrol may be considered as an adjunct to nonsurgical periodontal therapy, particularly in aggressive periodontitis but further well-designed trials are needed to determine optimal dosage, duration, and delivery route to support its potential as a complementary therapy for periodontitis.
PURPOSE:This pilot retrospective case series aimed to evaluate the 6-month clinical outcomes and safety of a combined regenerative protocol utilizing exosomes specifically designed for periodontal regeneration (Periosomes), with 90% anorganic bovine bone/10% collagen (ABBMC), and horizontal platelet-rich fibrin (H-PRF) for the treatment of advanced periodontal osseous defects. MATERIALS AND METHODS:This study analyzed stage-III (severe) periodontitis patients (from poor to hopeless prognosis) who underwent periodontal surgery using Periosomes with an ABBC/H-PRF scaffold with a 6-month follow-up. Complete periodontal charting, including probing depth (PD), gingival margin (GM), bleeding on probing (BOP), clinical attachment loss (CAL), gingival index (GI), plaque index (PI), and tooth mobility, was assessed at baseline and the follow-up. The study included 13 patients (8 females and 5 males) aged 29 to 73 years, with 23 periodontal defects of one-walled (60.9%) and two-walled (39.1%) defect morphology. RESULTS:The sites treated with Periosomes showed statistically significant reductions in PD from baseline to six months in one-walled defects (8.50 ± 2.41 mm to 3.14 ± 0.77; p 0.0001) and two-walled defects (7.56 ± 1.13 mm to 3.22 ± 0.44; p 0.0001) as well as in CAL from 9.14 ± 3.01 mm to 4.79 ± 2.17 (p 0.0001) in one-walled defects and from 7.22 ± 1.56 mm to 3.56 ± 1.01 (p 0.0001) in and two-walled defects. Furthermore, frequency distribution analysis found that 96% of sites attained residual PD 5 mm and 92% showed CAL gains ≥3 mm at the 6-month follow-up. CONCLUSION:The combined use of Periosomes, ABBMC, and H-PRF was associated with favorable short-term clinical improvements in advanced periodontal osseous defects with no reported adverse events. To our knowledge, this is the first human clinical study assessing the use of exosomes in periodontal regenerative therapy. However, controlled clinical trials with comparator groups and longer follow-up are necessary to evaluate the independent contribution of exosomes in periodontal regeneration.
PURPOSE:Vertical alveolar bone defects often require advanced augmentation techniques to enable successful implant placement. The aim of this study was to compare short-term vertical bone gain following two approaches: the bone-ring graft technique and guided bone regeneration (GBR) using a non-resorbable membrane in patients with vertical alveolar deficiencies. MATERIALS AND METHODS:A prospective cohort study was conducted involving 30 systemically healthy adult patients with posterior mandibular vertical bone defects measuring ≥4 mm. Participants were assigned to one of two treatment groups: Group A received the bone ring in conjunction with titanium implants and a resorbable collagen membrane; Group B was treated with allogeneic bone grafts and titanium-reinforced dense polytetrafluoroethylene (d-PTFE) membranes. Radiographic evaluations were performed at baseline, 1 week, 1 month, and 3 months postoperatively by cone-beam computed tomography (CBCT) and periapical radiographs. The primary outcome was vertical bone height gain. The data were analyzed using IBM SPSS Statistics Version 28.0. RESULTS:Group A demonstrated statistically significantly greater vertical bone gain at all postoperative intervals: 9.1 mm at 1 week, 10.6 mm at 1 month, and 9.7 mm at 3 months, compared to 7.8 mm, 7.0 mm, and 6.9 mm, respectively, in Group B (p 0.0001). Plaque index scores were comparable between groups, with no statistically significant differences observed in postoperative swelling or infection rates. However, membrane exposure was statistically significantly more frequent in Group B at all follow-up visits (p ≤ 0.02). CONCLUSION:The bone-ring graft technique was associated with greater vertical bone gain and a lower incidence of membrane exposure compared to GBR using a non-resorbable membrane. Further studies with longer follow-up are required to confirm these findings.
Background: Several research studies reported the anxiolytic and analgesic properties of nitrous oxide sedation, as well as its effectiveness in facilitating dental procedures for anxious populations, specifically, dental patients with high blood pressure. Objective: This clinical observational study aims to assess the impact of inhalation sedation using nitrous oxide mixed with oxygen on cardiovascular haemodynamics in hypertensive patients requiring dental treatment. Methods and Materials: Adult dental patients with hypertension and dental anxiety who attended the dental clinic with acute dental pain were included in the study. Non-invasive blood pressure (NI BP/mm Hg), heart rate (beats per min (bpm)), and oxygen saturation (SPO2%) were measured before, during, and after inhalation sedation. Participants' dental anxiety and need for conscious sedation were measured using the Modified Dental Anxiety Scale and the Indicator of Sedation Need, respectively. Dental procedure characteristics and sedation details were also collected, such as procedure type and duration, number of visits, and nitrous oxide concentration. Results: Significant reductions in heart rate and blood pressure were observed during and after the procedure compared with baseline. Mean heart rate decreased from pre-sedation to intraprocedural and post-procedural phases, while blood pressure shifted from pre-hypertensive or hypertensive levels to normal in most participants during and after sedation. Respiratory rate remained stable, and oxygen saturation was maintained at optimal levels throughout all phases. Conclusion: Inhalation sedation with nitrous oxide and oxygen was associated with reductions in heart rate and blood pressure in hypertensive patients undergoing dental treatment, while maintaining stable oxygen saturation. It was also associated with reduced dental anxiety and facilitation of dental procedures. These findings suggest a potentially beneficial role for inhalation sedation in this population; however, causal inferences are limited by the observational study design.
PURPOSE:This systematic review aimed to investigate a potential association between ankylosing spondylitis (AS) and periodontitis (PD), two chronic inflammatory diseases. METHODS AND MATERIALS:Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, searches were conducted in PubMed, The Cochrane Library, Scopus, and Web of Science. Keywords included 'spondyloarthritis', 'ankylosing spondylitis', 'periodontal diseases', and 'periodontitis'. Study selection was performed by independent authors, and quality was assessed using Scottish Intercollegiate Guidelines Network (SIGN) methodology and the STROBE-MR statement. RESULTS:Out of 255 initial studies, 18 eligible studies (3 cohort, 14 case-control, 1 Mendelian randomisation) were selected, all of acceptable to high quality. The prevalence of PD in AS patients showed conflicting results. Periodontal parameters like bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment loss (CAL) didn't consistently show statistically significant differences but were frequently correlated with AS parameters (eg, MASES, BASDAI, BASFI, CRP, AS duration). AS treatment with anti-TNF-α agents was associated with a decrease in PPD and CAL. Other findings included an increase in Gingival Index in AS patients treated with anti-TNF-α and mixed results for the Decayed, Missing, and Filled Teeth Index. Microbiological studies showed inconsistent results for Porphyromonas gingivalis (Pg), but anti-Pg IgG levels correlated with AS parameters. PD appeared to significantly increase inflammatory markers (IL-6, TNF-α, CRP, ESR) in AS patients. Only one study investigated a genetic association, finding none. CONCLUSION:A definitive conclusion regarding an increased prevalence of PD in AS patients cannot be drawn with certainty from this review, possibly due to heterogeneous classification criteria. However, the correlation between PD and AS parameters, alongside the impact of AS therapy on periodontal health, is noteworthy. Screening and treating periodontal disease in AS patients might delay symptom progression and reduce drug dosage, though targeted clinical trials are necessary to confirm these findings.
