BACKGROUND:This retrospective study evaluated whether clinical outcomes differed between connective tissue graft (CTG) and allogeneic solvent-dehydrated acellular dermal matrix (ADM) for treating multiple gingival recessions associated with non-carious cervical lesions (NCCLs) using partial restoration and the double-vestibular incision subperiosteal tunnel access (double-VISTA) technique. Factors associated with complete recession coverage (CRC) were also analyzed. METHODS:Electronic health records from an academic institution were reviewed. Cases included three or more adjacent teeth with RT1 or RT2 recessions treated with CTG or ADM using the double-VISTA technique and ≥12 months of follow-up. The primary outcome was CRC. Secondary outcomes included recession depth (RD) reduction, percentage of RD reduction, keratinized tissue width (KTW) gain, Class I buccal furcation coverage, and Modified Root Coverage Esthetic Score (MRCES). Multivariate generalized estimating equations identified predictors of CRC. RESULTS:A total of 226 teeth from 36 patients met inclusion criteria. CRC was significantly higher with CTG than ADM (80.0% vs. 48.8%, p < 0.001). CTG demonstrated greater RD reduction (2.57 ± 1.01 mm vs. 2.33 ± 0.77 mm, p = 0.019), percentage of RD reduction (89.9% vs. 80.6%, p < 0.001), KTW gain (0.39 ± 0.54 mm vs. 0.14 ± 0.35 mm, p < 0.001), and MRCES. Class I buccal furcation coverage was more frequent with CTG than ADM (53.8% vs. 9.1%, p = 0.028). RT1 defects, absence of Class I furcation involvement, thick gingival phenotype, and CTG as grafting material, were associated with CRC. CONCLUSION:CTG provided more favorable CRC, RD reduction, KTW gain, MRCES, and Class I furcation coverage compared with ADM. CRC was strongly associated with baseline recession type, furcation involvement status, gingival phenotype, and grafting material used. PLAIN LANGUAGE SUMMARY:This study looked at two commonly used soft tissue grafting materials for treating gum recession affecting multiple teeth, especially when teeth also had surface structure loss not caused by decay. The two materials compared were connective tissue graft (taken from the patient's hard palate) and a donated human-derived tissue product. Both were used together with a surgical method called the double-vestibular incision subperiosteal tunnel access (double-VISTA) technique. Researchers reviewed dental records from a university clinic and analyzed outcomes from 226 teeth in 36 patients who were followed for at least 1 year. The main goal was to evaluate how often complete root coverage was achieved. Other outcomes included how much the gum recession improved, changes in gum thickness, and whether gum tissue successfully covered mild furcation defects in molars. Overall, connective tissue grafts showed better results than human-derived tissues. Teeth treated with connective tissue grafts were more likely to achieve complete root coverage and showed greater improvement in gum recession depth. Connective tissue grafts also more frequently repaired furcation defects. Both materials were similarly effective at improving gum tissue thickness. Treatment success was also influenced by initial recession type, the presence of furcation defects before surgery, initial gum thickness, and grafting material used.
BACKGROUND:Periodontitis is a prevalent chronic inflammatory disease with a systemic inflammatory burden and is implicated with vascular pathology. This systematic review and meta-analysis evaluates the association between varying severities of periodontitis and ischemic stroke with various diagnostic criteria. METHODS:Following PRISMA 2020 (PROSPERO:1161816), PubMed (MEDLINE), Web of Science, and Scopus were searched from January 2000 to January 2026. Studies with clinically or radiographically diagnosed adult periodontitis patients were included. Studies reporting hazard ratios (HRs) and odds ratios (ORs) for ischemic stroke or cardiovascular outcomes with clear diagnosis and outcome definition were considered eligible. Study characteristics, diagnosis methods, periodontitis severity, outcomes, outcome ascertainment, follow-up duration, effect measures with 95% confidence intervals, and adjustment variables were extracted. The study quality was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS:Fifteen studies met the inclusion criteria: seven cohorts and eight case-controls. Pooled estimates showed an increased risk of ischemic stroke with periodontitis (HR = 1.24; 95%CI, 1.11-1.38; OR = 4.59; 95%CI, 1.81-11.62). Subgroup analysis revealed that severe periodontitis (OR = 4.19; 95%CI, 3.14-5.59) confers a greater risk than moderate disease (OR = 1.63; 95%CI, 1.16-2.29). New classification diagnostic criteria (AAP/EFP, CDC/AAP) produced stronger associations, OR = 5.35 (95%CI, 3.35-8.55), and a longer follow-up (≥ 15 years) amplified the risk (HR = 1.80; 95%CI, 1.33-2.44), supporting temporality. CONCLUSIONS:Severe periodontitis is significantly associated with ischemic stroke, with a consistent severity-related trend across studies. Therefore, meticulously diagnosed advanced periodontitis should be considered as a probable vascular risk factor and should prompt interdisciplinary management and patient education. PLAIN LANGUAGE SUMMARY:Gum disease (periodontitis) is a very common long-term inflammatory disease that affects the supporting tissue of the teeth. Increasing evidence suggests that periodontitis may also influence the general health of a person. In this study we focused particularly on ischemic stroke, the most common type of stroke. We analyzed data from multiple long-term research studies to determine if the severity of gum disease influences the risk of a person developing ischemic stroke. We found that the severe form of gum disease is significantly associated with ischemic stroke risk compared with individuals with healthy gums or a milder form of gum disease. This association is stronger in studies that used standardized diagnostic criteria and in studies with longer follow-up periods. This suggests that a systematically diagnosed severe gum disease is most likely to contribute to stroke development over time. These findings highlight the importance of early detection to properly manage gum disease. Closer collaboration between dental and medical professionals may improve preventive efforts and patient outcomes.
BACKGROUND:The prevalence of periodontitis increases with aging. The present study aimed to assess descriptively the changes in periodontal status over an 18-year period among individuals aged 60 and 66 years at baseline who participated in the Swedish National Study on Aging and Care in Karlskrona, Sweden. METHODS:This longitudinal study used quantitative methods based on data from the ongoing project, The Swedish National Study on Aging and Care (SNAC) in Karlskrona, Sweden. A total of 340 individuals aged 60 and 66 years underwent periodontal and radiographic examinations at baseline (2001-2003). Follow-up assessments were conducted after 12 years (2013-2015; n = 217) and after 18 years (2019-2021; n = 79). A paired t-test, McNemar's test, and binary logistic regression were performed for the statistical analysis. Statistical significance was determined at p < 0.05. RESULTS:Overall, the mean value BOP (SD) increased from 19.71(17.6) % at baseline to 32.73 (21.7) % at the 18-year follow-up (Cohen's d = ‒0.57; 95%CI: ‒0.81 to ‒0.33; p < 0.001). The proportion of participants with at least one site exhibiting a bone level ≥ 5 mm increased significantly, from 49.4% at baseline to 88.6% at the 18-year follow-up, corresponding to an absolute increase of 39.2 percentage points (p < 0.001). In addition, the prevalence of periodontitis increased from 7.8% to 19.5% over the same period, an absolute increase of 11.7 percentage points (p = 0.035). CONCLUSIONS:The present study indicates that periodontal status deteriorates over 18 years among participants aged 60 and 66 years at baseline. PLAIN LANGUAGE SUMMARY:This study followed an older population over an 18-year period to describe how their periodontal status (gum conditions, periodontal pocket depth, and alveolar bone levels) changed over time. The participants were part of the Swedish National Study on Aging and Care in Karlskrona, Sweden. A total of 340 individuals who were 60 or 66 years old at the start (2001-2003) were included. They underwent periodontal and radiographic (x-ray) examinations at baseline and again after 12 years (2013-2015) and 18 years (2019-2021). Over time, periodontal status worsened, with more inflammation, more bone loss around the teeth, and a higher proportion of individuals classified as having periodontitis according to the definition used in this study.
BACKGROUND:Periodontitis has been associated with other systemic inflammatory diseases, such as cardiovascular disease, diabetes mellitus, and rheumatoid arthritis; through the translocation of oral bacteria and local inflammatory mediators systemically. Establishing potential associations between periodontitis and gastric disorders may contribute to the prevention and management of both conditions. This study has three aims: Aim 1, investigate associations between functional dyspepsia and periodontitis; Aim 2, assess the association between gastric Helicobacter pylori and periodontitis; Aim 3, evaluate the effect of periodontal treatment on the eradication of gastric H. pylori. METHODS:Medline, EMBASE, other databases, and Google Scholar were electronically searched during March 2026. All observational and trial studies conducted on adult humans were selected. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was employed to assess the overall body of evidence. The Newcastle-Ottawa Scale and the Risk of Bias2 tool were applied to assess risk of bias in the included studies. Meta-analysis was conducted using Review Manager 5.4. RESULTS:Fourteen papers were selected. Most studies demonstrated an association between periodontitis and various gastric problems. Meta-analysis for aims 2 and 3 showed an association between periodontitis and gastric H. pylori, pooled odds ratio (POR) = 1.66 (95% confidence interval [CI] 1.22-2.27). Additionally, a positive effect of combining periodontal and systemic therapy on complete eradication of H. pylori was observed, POR = 2.94 (95% CI 1.15-7.51). CONCLUSION:An association between periodontitis and several gastric disorders, particularly H. pylori gastritis has been demonstrated. Moreover, adding non-surgical periodontal treatment to the standard systemic antibiotic regimen showed to enhance eradication of gastric H. pylori. Future research is needed. PLAIN LANGUAGE SUMMARY:Gum disease, particularly periodontitis, is linked to other health problems, such as diabetes, heart disease, and rheumatoid arthritis. This review looked at whether there is a link between gum disease and stomach disorders. Three aims were set: Aim 1, to look at the possible connection between gum disease and indigestion (functional dyspepsia); Aim 2, to look at the possible connection between gum disease and stomach infection with Helicobacter pylori; and Aim 3, to see if treating gum disease can help clear stomach infection if combined with the standard stomach infection treatment with antibiotics. Medical databases were searched for relevant studies up to March 2026. As a result, 14 studies were included. Most of these included studies showed a connection between gum disease and stomach infection (odds ratio 1.66). Studies showed that combining gum disease treatment with the standard treatment for stomach infection can help in complete clearance of H. pylori infection (odds ratio 2.94). This review showed a connection between gum disease and stomach problems, and combining gum disease treatment with the standard treatment of stomach infection helps in completely clearing H. pylori infection. However, further research is needed to confirm these findings.
BACKGROUND:This retrospective study aimed to assess the prevalence of postoperative infections after periodontal and implant surgical therapy and examined the treatment variables that may affect infection prevalence. METHODS:A retrospective review on patients who were surgically treated in the graduate periodontics clinic at the University of Texas at San Antonio School of Dentistry was performed. Surgeries included osseous surgery, extractions, alveolar ridge preservation, guided tissue regeneration, implant placement, treatment of peri-implantitis, guided bone regeneration, crestal and lateral sinus augmentation, and mucogingival surgery. Postoperative infections that occurred within the first 2 weeks of healing were recorded. Postoperative infection prevalence was compared between procedures with and without specific treatment variables (e.g., bone grafts, biologics, membranes, antibiotics, chlorhexidine rinse, surgical dressing). RESULTS:Of the 18,505 procedures included in this study, 217 had postoperative infections resulting in an overall infection prevalence of 1.17% at the procedure-level. The prevalence varied from 0-5% based on procedure type, with guided bone regeneration demonstrating the highest prevalence. On a patient-level 176 patients experienced at least one postoperative infection, resulting in a patient-level infection prevalence of 4.06% (95%CI, 3.51%-4.69%). The Random Forest Model showed the use of biologics and antibiotics correlated with increased infection prevalence; however, these agents were generally utilized for more complex surgeries with an inherently greater risk of infection. Bone grafts, membranes, and chlorhexidine prescription did not show a major influence on infection prevalence. CONCLUSIONS:The post-surgical infection prevalence of periodontal surgery is low. These findings do not support the routine use of perioperative antibiotics as a preventive measure for infections. Rather than implementing routine administration, clinicians must evaluate the necessity of post-surgical antibiotic therapy on an individual basis. This assessment should comprehensively account for the patient's medical history, the specific surgical procedure, the complexity of the treatment, and the incorporation of biomaterials. Prospective studies are needed to elucidate the role antibiotics and biomaterials have on post-surgical infections.
BACKGROUND:Epidemiological studies show periodontitis and type 2 diabetes share a bidirectional aggravating relationship, yet the molecular mechanisms linking systemic metabolic dysregulation to local periodontal destruction remain unclear, and effective therapies for this comorbidity are lacking. Certain G protein-coupled receptors (GPCRs) enhance insulin secretion and attenuate inflammation. We hypothesized that GPCR regulators may contribute to crosstalk between systemic metabolic abnormalities and periodontal immunopathology. METHODS:Using db/db mice with ligature-induced periodontitis, we performed multi-tissue transcriptomics of gingiva, colon, and small intestine combined with weighted gene co-expression network analysis (WGCNA) to identify GPCR-related candidates. The selective G protein-coupled receptor 120 (GPR120) agonist TUG-891 was administered to evaluate therapeutic effects on metabolic parameters and alveolar bone loss. In vivo and in vitro experiments, including gingival tissue immunofluorescence, PicoGreen dsDNA quantification, and western blotting were used to assess NET- and NLRP3-related responses. RESULTS:WGCNA identified GPR120 as a shared GPCR-related candidate across three tissues in diabetic periodontitis, with upregulation confirmed in gingiva. TUG-891 partially alleviated hyperglycemia, dyslipidemia, and alveolar bone loss. GPR120 activation reduced NET-associated signals in vivo and in vitro, downregulated calcium/potassium signaling (upstream NLRP3 activators), and decreased LPS/glucose-induced upregulation of NLRP3 and ASC in neutrophils. The NLRP3 inhibitor MCC950 phenocopied, while the NLRP3 activator nigericin reversed, the NET-associated changes of TUG-891. CONCLUSIONS:This study identifies GPR120 as a factor associated with metabolic stress and periodontal destruction in diabetic periodontitis, and suggests that the signaling involving GPR120, NLRP3-related responses, and NET-associated inflammation may hold therapeutic potential for this common diabetic complication.
BACKGROUND:Demineralized freeze-dried bone allograft (DFDBA) is widely utilized in alveolar ridge preservation (ARP). However, limited human histologic evidence exists characterizing early healing associated with aseptically processed large-particle DFDBA. Both graft processing methodology and particle size may influence regenerative healing dynamics, graft integration, and tissue maturation. METHODS:Three systemically healthy patients underwent ARP following tooth extraction using aseptically processed large-particle DFDBA (850-2000 µm) and dense polytetrafluoroethylene (d-PTFE) membrane coverage. Core biopsies were harvested at implant placement after 13-17 weeks of healing. Histologic and histomorphometric analyses were performed to evaluate graft integration, newly formed bone, residual graft particles, connective tissue, cellular repopulation, and tissue mineralization patterns. RESULTS:All specimens demonstrated active bone formation, graft integration, and cellular repopulation of residual DFDBA particles. Newly formed bone was observed in close apposition to graft particles, consistent with ongoing remodeling and incorporation at the graft-host interface. Mean vital bone formation was approximately 34%, while mean mineralization approached 90%. Residual graft particles remained present at all sites and demonstrated varying degrees of integration into newly formed tissue. Cone beam computed tomography (CBCT) evaluation demonstrated regions of reduced radiopacity suggestive of incomplete mineralization; however, histologic and histomorphometric analyses demonstrated highly mineralized regenerated tissue, highlighting differences between radiographic appearance and tissue maturity during early healing. CONCLUSION:Within the limitations of this exploratory case series, aseptically processed large-particle DFDBA demonstrated early healing characterized by graft integration, cellular repopulation of graft particles, vital bone formation, mineralized tissue development, and progressive remodeling following alveolar ridge preservation. Histologic and histomorphometric findings obtained at 13-17 weeks provide direct human evidence regarding early healing patterns associated with a graft configuration defined by both aseptic processing methodology and large particle size. Mean vital bone formation of approximately 35% and mean 90% mineralization were observed during this early healing interval, and all sites demonstrated sufficient clinical development to permit subsequent implant placement. PLAIN LANGUAGE SUMMARY:When a tooth is removed, the surrounding bone naturally shrinks during healing, which can make future dental implant placement more difficult. One way to reduce this bone loss is alveolar ridge preservation, in which a bone graft is placed into the extraction socket. This study evaluated early healing following ridge preservation using an aseptically processed human donor bone graft composed of relatively large particles. Three healthy patients received the graft after tooth extraction. Approximately 13-17 weeks later, small bone samples were collected during routine implant site preparation and examined microscopically. In all cases, new bone formation was observed, and the graft particles showed evidence of integration with the surrounding tissue. Many particles were repopulated with living bone cells, indicating active remodeling. Although radiographs suggested that healing was still ongoing, microscopic analysis demonstrated a high degree of mineralization within the regenerated tissue. Within the limitations of this small case series, these findings provide insight into early healing patterns associated with this graft material and support further investigation in larger clinical studies.
BACKGROUND:More evidence is needed to assess the association between periodontitis and Oral Health-Related Quality of Life (OHRQoL) quantitatively. We hypothesized that periodontal inflammation is correlated with a worsening in quality of life and aimed to test this in this study. METHODS:A total of 1307 participants in King's Oral Biobank answered the Oral Health Impact Profile-14 (OHIP-14) questionnaire (measurement of OHRQoL) during a dental visit. The associations between periodontal inflammation, measured as periodontal inflamed surface area (PISA) and bleeding on probing (BOP), periodontal conditions (diagnosis/staging), and OHIP-14 scores across all seven domains (functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap) were investigated. RESULTS:The PISA exhibited weak linear correlations with the overall OHIP-14 score (Pearson correlation coefficient r = 0.06, p = 0.037), particularly with the "physical pain" subdomain (r = 0.12, p < 0.001). BOP was associated with the OHIP overall score (r = 0.08, p = 0.022). In addition, stage IV periodontitis was associated with higher OHIP-14 total scores and with multiple subdomains, including physical pain, physical disability and psychological discomfort. CONCLUSIONS:Inflammation indices such as BOP and PISA are associated with worse OHRQoL. In addition, the complex clinical features of stage IV periodontitis may worsen OHRQoL, especially in relation to physical pain, physical disability and psychological discomfort. PLAIN LANGUAGE SUMMARY:This study shows that having more advanced gum disease (stage IV) and gum inflammation may worsen quality of life.
BACKGROUND:Emerging evidence has demonstrated a bidirectional relationship between periodontal disease and cardiovascular outcomes, with periodontal inflammation contributing to systemic vascular dysfunction. Herein, we aimed to assess the available evidence on whether periodontal therapy improves cardiovascular and inflammatory outcomes in patients with periodontitis through the systematic modulation of blood pressure and C-reactive protein levels. METHODS:Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and the population, intervention, comparison, outcomes, and study design (PICOS) question, electronic databases were screened from inception to January 2025 for randomized controlled trials addressing the impact of periodontal interventions on systolic and diastolic blood pressure and C-reactive protein outcomes in patients with periodontitis. Studies were selected, and data were extracted by two independent reviewers. Random-effects models were applied to perform meta-analyses, and the Cochrane Risk of Bias 2 (RoB2) tool was used to assess study quality. RESULTS:Twelve randomized controlled trials were included in the qualitative and quantitative syntheses. The meta-analysis demonstrated that periodontal therapy significantly reduced systolic (mean difference, -4.64 mmHg; 95% CI, -5.99 to -3.30) and diastolic blood pressure (mean difference, -1.84 mmHg; 95% CI, -2.65 to -1.02). Concurrent anti-inflammatory effects were evident through significant reductions in C-reactive protein levels (mean difference, -0.58 mg/L; 95% CI -0.83 to -0.33). CONCLUSION:Periodontal therapy shows potential cardiovascular and anti-inflammatory benefits through reductions in blood pressure and C-reactive protein levels, although evidence certainty was moderate to low, and high-quality trials powered for blood pressure endpoints are warranted to strengthen this evidence. PLAIN LANGUAGE SUMMARY:Periodontal disease has been linked to heart and blood vessel problems via inflammation, which affects the entire body. This study analyzed randomized controlled trials to determine whether treating gum disease could help to reduce cardiovascular risk by lowering blood pressure and inflammatory markers. Our analysis showed that periodontal therapy led to meaningful reductions in both systolic and diastolic blood pressure, with improvements similar to those observed with blood pressure medications, while also reducing C-reactive protein levels, indicating less systemic inflammation. These findings suggest that treating gum disease may provide important benefits for heart health and should be considered part of overall cardiovascular disease prevention strategies. However, more standardized investigations are needed to strengthen these conclusions and to help healthcare providers better understand how dental treatment fits into comprehensive heart disease prevention.
BACKGROUND:This 6-year observational follow-up of a randomized, parallel-arm clinical trial evaluated the association between toothbrush type and periodontal phenotype on the long-term stability of the gingival margin (GM) following coronally advanced flap (CAF) surgery. METHODS:Thirty-one of the original 60 subjects were reevaluated after 6 years. Treated gingival recessions were allocated to manual or oscillating-rotating toothbrush use. Periodontal phenotype was qualitatively assessed at baseline using a color-coded probe. Recession depth (RD), mean root coverage (mRC), and complete root coverage (CRC) were recorded over time and compared between groups. Data were analyzed using random-intercept models and non-parametric tests (α = 0.05). RESULTS:GM relapse occurred in both groups. Loss of CRC occurred earlier in the manual toothbrush group (6 months) than in the oscillating-rotating group (2 years). At 6 years, both groups showed a significant reduction in CRC (manual: 58.8%, p < 0.001; oscillating-rotating: 57.1%, p < 0.001), with no statistically significant differences between toothbrush types. Periodontal phenotype and oscillating-rotating toothbrush use, assessed at the 6-year time point, were associated with greater GM stability. CONCLUSIONS:Within the limitations of this 6-year follow-up, CAF surgery in thin and medium periodontal phenotypes was associated with gingival recession recurrence over time, while oscillating-rotating toothbrush use was associated with delayed GM breakdown.
BACKGROUND:The clinical efficacy of growth factors in regenerative procedures may depend on both dosage and sustained delivery during critical phases of healing. This study aimed to evaluate in vitro release kinetics of platelet-derived growth factor-BB (PDGF-BB) from various graft materials, including recombinant human PDGF-BB (rhPDGF-BB) combined with beta-tricalcium phosphate (β-TCP), leukocyte platelet-rich fibrin (L-PRF) with β-TCP (PRF bone block), L-PRF bone block with added rhPDGF-BB, and L-PRF membranes alone. METHODS:Whole blood samples were collected from five healthy adult donors. L-PRF membranes and autologous liquid fibrinogen were prepared according to manufacturer's protocols. Five samples of each of the following were prepared: L-PRF membranes, L-PRF + β-TCP with or without rhPDGF-BB, and β-TCP + rhPDGF-BB. All materials were incubated at 37°C, and 2 mL aliquots of supernatant were collected at 1 hour, 8 hours, 1 day, 3 days, and 10 days. PDGF-BB concentrations were quantified using enzyme-linked immunosorbent assay (ELISA), and data were analyzed using a linear mixed effects model with Tukey's post hoc test. RESULTS:Significantly higher PDGF-BB concentrations were observed in samples containing rhPDGF-BB at all-time points. Further, the L-PRF + rhPDGF-BB + β-TCP group demonstrated a gradual and sustained release from 1 hour to 10 days. In contrast, the rhPDGF-BB + β-TCP group showed an early peak followed by minimal release after day 3. CONCLUSION:The incorporation of L-PRF into β-TCP scaffolds containing rhPDGF-BB resulted in prolonged and more controlled PDGF-BB release. Composite graft formulation may maintain growth factor availability during early and intermediate phases of healing. PLAIN LANGUAGE SUMMARY:This study was designed to determine how different materials release a healing protein, PDGF-BB, over time. This protein helps tissues regenerate, and its effectiveness depends on both how much is delivered and how long it stays active during healing. Four combinations of composite graft materials were tested using blood from healthy donors: (1) laboratory-produced version PDGF-BB with a synthetic hard tissue graft (β-TCP), (2) autologous blood product (L-PRF) with β-TCP, (3) L-PRF with β-TCP plus added laboratory-produced PDGF-BB, and (4) L-PRF alone. PDGF-BB release was measured at different times over 10 days. Composite grafts with added laboratory-produced PDGF-BB released more of the protein overall. The combination of L-PRF, β-TCP, and synthetic PDGF-BB released the protein slowly and steadily over time. The synthetic PDGF-BB with β-TCP alone released a lot early on, but very little after day 3. Based upon these findings and within the limitation of this study, use of composite grafts containing L-PRF with β-TCP and laboratory-produced PDGF-BB may help improve healing by keeping the growth factor available longer during the most important stages of tissue repair. Further clinical studies are necessary to determine the comparative clinical benefits of such composite grafts.
BACKGROUND:The periodontal inflamed surface area (PISA) estimates the area of inflammatory burden of periodontal disease. This methodological study accessed PISA and its constituents, and systemic C-reactive protein correlations in an attempt to define different tools to investigate the periodontal-systemic interface. METHODS:Data from the Buffalo OsteoPerio cross-sectional study (1997-2001) were used. The full-mouth periodontal probing depth (PPD) and clinical attachment loss (CAL) at six sites per tooth, and marginal bleeding (MB) at three sites per tooth from 713 post-menopausal women were included. Fasting blood and saliva log-transformed C-reactive protein values were used. RESULTS:A significant increase of MB (30 ± 20/43 ± 26), CAL (1.8 ± 0.3/3.1 ± 0.8), PPD (1.7 ± 0.2 /2.3 ± 0.4), PISA (220.5 ± 162.5/472.1 ± 324.6), and C-reactive protein (medians in mg/L), for saliva (0.43/0.67) and serum (2810/3882), was observed with increasing severity of periodontitis. Overall, the highest intercorrelations occurred for indices based on similar periodontal measures, as observed for PPD of whole mouth and of sites measured for bleeding (r = 0.960). Correlations between PISA and C-reactive protein were weak for saliva [maximum of 0.088 (0.015, 0.161) and serum (maximum 0.048 (-0.027, 0.123)]. MB presented a consistent pattern of correlations with C-reactive protein, even weak [maximum of 0.254 (0.085, 0.409) for severe periodontitis]. For serum C-reactive protein, no significant correlations were found. CONCLUSIONS:The extent of MB consistently correlated to C-reactive protein, while a higher correlation with PISA could not be determined. The results of the present investigation do not support the use of PISA as a clinical tool in place of, or adjuvant to, the extent of gingival bleeding present when exploring periodontal inflammation and its potential interface with systemic conditions. PLAIN LANGUAGE SUMMARY:The diagnosis of periodontal disease may be performed using different tools. In this study, the authors tested a tool that evaluates the area of inflamed periodontium (PISA), and its components to evaluate the periodontal-systemic interface, using C-reactive protein as a marker of systemic inflammation. Interestingly, the percentage of sites positive for bleeding showed higher correlations with C-reactive protein than PISA. Although PISA has gained some followers, our results showed that its calculation may not be needed for evaluating the periodontal-systemic interface.
BACKGROUND:Despite the introduction of the 2017 periodontal disease classification system to enhance diagnostic accuracy, several concerns persist regarding its implementation in clinical situations. The prevalence of diagnostic errors in periodontics remains relatively high, with limited data available on the impact of different training levels and institutional approaches on the diagnostic accuracy and competency of students and practitioners. This study aims to explore the patterns of diagnostic accuracy and perceived confidence and familiarity with utilizing the 2017 periodontal classification system across various levels of clinical complexity, different educational levels, and two Canadian institutions METHODS: This prospective cross-sectional study included 104 participants from two universities, including third- and fourth-year dental students, dental hygiene degree students, periodontics residents from five programs, and clinical instructors in periodontics and dental hygiene. Participants were asked to diagnose five de-identified clinical cases along the spectrum of periodontal health and disease. Gold standard diagnoses were established by board-certified periodontists. Diagnostic accuracy, error patterns, and factors influencing diagnostic decisions were analyzed using chi-square tests, t-tests, and a content analysis approach. RESULTS:The overall diagnostic accuracy ranged from 18.3% to 53.8%. Clinical instructors achieved the highest accuracy (58.3%), followed by residents (52.9%), fourth-year dental students (45.2%), dental hygiene degree students (36.5%), and third-year dental students (26.4%). Statistically significant institutional differences were identified in Cases 1 (χ2 = 7.62, p = 0.01) and 4 (χ2 = 4.04, p = 0.05). Common errors included underdiagnosis (32.4%), incorrect periodontal status identification (28.7%), and wrong extent classification (21.3%). Qualitatively, participants frequently described the classification system as "ambiguous" with substantial "gray zones". CONCLUSIONS:Regardless of the training level, diagnostic accuracy with the 2017 classification system remains suboptimal. Institutional variations suggest that curricular approaches may significantly impact the development of diagnostic skills and their diagnostic competency. These findings highlight the need for calibration protocols, targeted teaching and learning interventions, and technology-supported learning tools to improve diagnostic skills in periodontal education.
BACKGROUND:The aim of this study is to evaluate the gingival crevicular fluid (GCF) levels of inflammatory markers in both primary and permanent dentitions affected with grade C molar-incisor pattern periodontitis (C-MIP) before and after periodontal therapy. METHODS:Patients from an African American cohort (both sexes; aged 5-21 years) diagnosed with C-MIP in the primary (n = 26) or permanent (n = 44) dentitions were included. After periodontal evaluations, patients received non-surgical periodontal treatment (mechanical debridement with cavitron and hand scaling as needed and 1 week of systemic amoxicillin/metronidazole regimen with dosage modifications for patients weighing under 40 kg). GCF samples were collected from both healthy and diseased sites at baseline, and at 3-, 6-, and 12-months post-therapy, during periodontal maintenance. Levels of 14 cytokines/chemokines were analyzed using multiplex. GCF levels between primary and permanent dentitions and among timepoints were evaluated along with clinical parameters (e.g., probing depth [PD], clinical attachment level, bleeding on probing [BoP], and plaque [PI]). RESULTS:Overall, clinical parameters were improved following treatment in both dentitions up to 12 months. Several cytokines/chemokines were higher in the diseased sites compared with the healthy sites at baseline in both dentitions (p < 0.05). Following treatment, eotaxin reduced in both dentitions in diseased sites (p < 0.05), while other markers were specifically reduced in the permanent (granulocyte-macrophage colony-stimulating factor [GM-CSF], interleukin [IL]-1β, IL-6, IL-8, IL-12p40, tumor necrosis factor-alpha [TNF-α]) dentition. However, some markers, such as eotaxin, IL-1β, IL-2, IL-8, IL-10, IL-12p40, MIP-1α and TNF-α although reduced by 3-, 6-months, showed a tendency of rebound by 6 and 12 months, especially in permanent dentition. Eotaxin and MCP-1 were higher in diseased sites at baseline in the permanent dentition while GM-CSF and interferon-gamma [IFN-γ] in the primary one (p < 0.05). Several cytokines/chemokines were correlated with clinical parameter reductions, and profile analysis showed differences between dentitions up to 6 months. CONCLUSION:Non-surgical therapy combined with systemic antibiotics improved clinical (e.g., PD, CAL, and number of affected sites) outcomes with reductions in pro-inflammatory cytokine/chemokine levels in both primary and permanent dentitions of patients with C-MIP in the long term, with some specific differences observed between the dentitions (NCT01330719).
BACKGROUND:Pre-surgical anxiety (PSA) and pre-surgical fear (PSF) may hinder patient compliance, while patient satisfaction (PS) is vital for adherence to treatment recommendations. This prospective study investigated the impact of PSA and PSF, and the influence of patient demographics and postoperative pain, on PS after periodontal and implant surgeries. METHODS:Seventy-four patients, ≥ 18 years, who underwent periodontal and implant surgeries were recruited. PSA and PSF were measured using the Modified Dental Anxiety Scale (MDAS) and Dental Fear Survey (DFS). PS was evaluated 2 weeks post-surgery using the Dental Satisfaction Questionnaire (DSQ). Pain was recorded (visual analogue scale; VAS) on day 1 and 2-weeks post-surgery. Pearson correlation was used to examine relationships, and independent samples t-tests analyzed demographic effects. RESULTS:Pre-surgical DFS was negatively correlated with DSQ (r = -0.3, p = 0.009), while MDAS had no significant correlation (p > 0.05). Day- 1 DFS, and MDAS were negatively correlated with DSQ, (r = -0.378, p < 0.001; r = -0.391, p < 0.001; respectively). Change in pain scores over time were negatively correlated with DSQ (r = -0.317, p = 0.006; r = -0.271, p = 0.02; respectively). DSQ increased with age (p = 0.014) but showed no differences by sex or procedure type. CONCLUSIONS:PSF, younger age, and greater pain changes were associated with lower satisfaction. Considering the study limitations (absence of multivariate modeling, limited sample size), these findings should be considered with caution. Further comparative studies are warranted to evaluate strategies for managing fear and anxiety. PLAIN LANGUAGE SUMMARY:Patients who felt more fearful before their periodontal or implant surgery tended to be less satisfied with their experience, while anxiety did not seem to affect patient satisfaction. Older patients reported higher satisfaction than younger ones, but sex did not make much difference. Experiencing more change in pain and discomfort over time was linked to feeling less satisfied. The results of this study suggest that reducing pre-treatment fear and managing early postoperative pain could improve patients' overall satisfaction with their periodontal and implant surgical treatment.
BACKGROUND:The purpose of this study is to investigate the feasibility and diagnostic accuracy of ultrasonography in peri-implant defect identification and evaluation, and to compare ultrasonography (USG) with cone-beam computed tomography (CBCT) in defect identification and evaluation in an in vitro model. METHODS:Seventy-two implants were placed in fresh porcine rib bone models with different types of artificially created defects (including buccal dehiscence, circumferential defect, circumferential defect with buccal dehiscence), and in control sites with no defect. Both USG and CBCT were used to assess the presence, type, and linear measurements (height and depth) of the defects. Diagnostic performance metrics, including the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of USG and CBCT in characterizing different types of defects, were examined. Linear measurement results obtained by using USG and CBCT were compared with the direct measurement as the gold standard, with the computation of the intraclass correlation coefficient (ICC). RESULTS:USG demonstrated satisfactory diagnostic accuracy (> 95%) in defect type detection across all types. Its sensitivity in detecting circumferential defects (83.3%) and its positive predictive value for no-defect sites (87.0%) were lower. CBCT showed perfect diagnostic accuracy (100%) for defect detection. USG illustrated high agreement with direct measurements for defect depth (ICC = 0.934, p < 0.001) but poor agreement for defect height (ICC = 0.349, p < 0.001), underlining its limitations compared with CBCT. CONCLUSIONS:USG is a reliable, non-ionizing diagnostic tool for characterizing peri-implant defect types with performance comparable to CBCT. However, it underestimates defect height measurements in defects with infrabony components, where CBCT remains superior.
BACKGROUND:Free soft tissue autografts (FSTA) harvested from a patient's palate are frequently associated with significant postoperative morbidity. Several wound dressings have been applied to the palatal donor site with the aim of reducing postoperative complications and improving wound healing. Periodontal literature on the use of an amnion-chorion membrane (ACM) for this indication is limited, despite its antimicrobial, angiogenic, and anti-inflammatory properties. METHODS:Patients requiring an autogenous soft tissue graft were randomized into receiving either an ACM or hemostatic agent (HA) palatal wound dressing following the harvest of an epithelialized FSTA. Early wound healing was assessed at 1, 2, 3, and 4 weeks following surgery using an Early Healing Index (EHI) that assessed bleeding on palpation, incomplete epithelialization, granulation tissue, inflammation, and redness. Postoperative questionnaires assessing a patient's pain level on a 21-point Numeric Rating Scale (NRS-21) and analgesic consumption over the first 72 h after the procedure were also evaluated. RESULTS:Healing improved significantly in both treatment groups over the study period. Over all 4 weeks, EHI scores were significantly higher in the ACM treatment group by 1.17 points (p = 0.027). There was no significant difference in NRS-21 scores or analgesics consumed between groups. Graft dimensions did not significantly affect either parameter assessed, but higher patient age was associated with higher EHI scores. CONCLUSION:ACM resulted in improved early wound healing compared to HA when applied as a palatal donor site wound dressing following a FSTA harvest. Therefore, ACM may be an appropriate palatal wound dressing for patients with anticipated delayed healing. CLINICAL TRIAL NUMBER:Clinicaltrials.gov NCT05400213.
BACKGROUND:The aim of this study is to investigate the association between tooth loss and cognitive decline and to explore the potential role of salivary microbial genera in this relationship in a nationally representative population. METHODS:Data from 1,413 adults aged ≥ 60 years in NHANES 2011-2012 were analyzed. Cognitive function was assessed using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word Learning Tests, the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST). Salivary microbiome profiles were obtained from a subsample of 661 participants using 16S rRNA sequencing. Complex survey regression, PERMANOVA, and multivariable microbial association analyses were applied. Mediation analyses were conducted as exploratory analyses to evaluate potential microbial pathways linking tooth loss with cognitive outcomes. RESULTS:Moderate tooth loss was associated with higher odds of low global cognition (OR = 2.91, 95%CI: 2.01-4.23), low AFT (OR = 1.57, 95%CI: 1.03-2.39), and low DSST (OR = 2.15, 95%CI: 1.47-3.16) after adjustment. Sixteen genera were associated with at least one cognitive metric, including Prevotellaceae_NA, Phocaeicola, and Lactobacillus. In exploratory mediation analyses, three organic acid-producing genera (Lactobacillus, Lachnospiraceae_NA, and Leptotrichiaceae_NA) were identified as potential contributors to the association between tooth loss and cognition. CONCLUSION:Tooth loss was associated with cognitive decline in older adults, and both conditions were accompanied by differences in salivary microbial composition. Exploratory mediation analyses suggested that certain organic acid-producing taxa may contribute to the observed association. PLAIN LANGUAGE SUMMARY:Tooth loss is common in older adults and has been linked to problems with memory and thinking, but the reasons for this connection are not fully understood. In this study, we used data from a large national health survey of adults aged 60 years and older to examine tooth loss, results from several cognitive tests, and the types of bacteria found in saliva. We found that older adults with more missing teeth were more likely to perform poorly on tests measuring memory, attention, and processing speed. We also observed that some types of oral bacteria were related to both tooth loss and cognitive performance. In exploratory analyses, several groups of bacteria that produce organic acids were linked to the relationship between tooth loss and cognitive outcomes. These findings suggest that differences in the oral microbial community may be one of several biological pathways connecting oral health and cognitive function. Understanding how oral health, diet, and oral bacteria interact may help researchers better understand factors related to cognitive aging and to identify potential targets for future research and prevention strategies.
BACKGROUND:The aim of this study is to investigate the relationship between reported vitamin C intake and gingival bleeding severity. METHODS:In this cross-sectional study, 336 participants were screened, and 262 (118 females, 144 males) were eligible. Vitamin C intake was derived from the Food Frequency Questionnaire (FFQ). The body mass index (BMI), plaque index (PI), bleeding on marginal probing (BOMP), and bleeding on pocket probing (BOPP) were scored. Means and standard deviations (SD) were calculated overall and by sex. Spearman's correlations assessed links between vitamin C intake and clinical variables. Sex differences were analyzed using Fisher's exact test and the Mann-Whitney U test. Generalized regression models evaluated relationships between BOMP/BOPP and vitamin C intake, sex, age, and PI. RESULTS:The participants had a mean age of 22.6 years, mean BMI of 22.9 kg/m2, and mean PI of 0.98. Average daily vitamin C intake was 108 mg (SD = 53), ranging from 19 to 425 mg. Mean BOMP and BOPP scores were 0.38 and 0.52, respectively. Regression models revealed no significant associations between vitamin C intake and BOMP or BOPP. However, PI was positively associated with both bleeding indices, while age was negatively associated. CONCLUSION:In this non‑deficient young adult population, vitamin C intake was not significantly associated with gingival bleeding after adjusting for covariates. Gingival bleeding was positively associated with PI and negatively with age.
BACKGROUND:The biofunctionalization of collagen matrices (CMs) with injectable platelet-rich fibrin (i-PRF) has been proposed to enhance their bioactivity and clinical efficacy in the treatment of gingival recessions (GRs). This study evaluated the use of a volume-stable collagen matrix (VCMX) biofunctionalized with i-PRF as an adjunct to the coronally advanced flap (CAF) for single GRs. METHODS:Seventy-five patients with single RT1 GR were randomly assigned to CAF, CAF+VCMX, or CAF+VCMX+iPRF. Clinical, esthetic, and patient-centered outcomes were assessed at baseline and at 6 months. RESULTS:All groups resulted in significant recession reduction (CAF: 1.93 ± 0.86 mm; CAF+VCMX: 1.64 ± 0.68 mm; CAF+VCMX+iPRF: 1.70 ± 0.84 mm), with no statistically significant differences among groups (p = 0.36). Groups treated with VCMX showed greater gingival thickness (GT) gain (CAF: 0.18 ± 0.25 mm; CAF+VCMX: 0.39 ± 0.26 mm; CAF+VCMX+iPRF: 0.45 ± 0.29 mm), favoring CAF+VCMX+iPRF (p < 0.001). No significant keratinized tissue width (KTW) gain was observed (p > 0.05). Adjusted models identified baseline KTW and KTW gain as positive predictors of complete root coverage (CRC), and KTW gain as the main predictor for RecRed and %RC. CONCLUSIONS:All approaches were effective in reducing GR and improving clinical parameters. The iPRF addition to the VCMX may not improve root coverage outcomes (NCT05916742). PLAIN LANGUAGE SUMMARY:Gingival recession, or receding gums, occurs when the gum moves away from the tooth, exposing the root of the tooth. This can cause sensitivity and esthetic concerns and increase the tooth's susceptibility to problems. A common surgical treatment is the coronally advanced flap (CAF), which repositions the gum to cover the exposed root. In some cases, dentists add a collagen matrix to help thicken the gum and to improve the outcome. A newer option enhances this matrix with a patient's own blood product called injectable platelet-rich fibrin (i-PRF), which may improve healing. This study included 75 patients with a single recession defect. They were randomly assigned to one of three treatments: CAF alone, CAF with a collagen matrix, or CAF with a collagen matrix enhanced with i-PRF. After 6 months, all treatments led to similar improvements in root coverage, sensitivity, and esthetics. However, patients who received the collagen matrix, especially when combined with i-PRF, developed thicker gum tissue. Thicker and wider gum tissue is associated with better long-term outcomes. All procedures were well tolerated and caused minimal discomfort. Overall, adding a collagen matrix, particularly when enhanced with i-PRF, may support thicker gums and help to maintain long-term results.
