BACKGROUND:Aging is a multifactorial process marked by gradual cellular dysregulation, regulated by hallmarks, including genomic instability, mitochondrial dysregulation, and chronic inflammation. Extracellular vesicles (EVs), especially exosomes, have emerged as pivotal mediators of cell-to-cell communication with potential roles in both enhancing and alleviating aging. This review aimed to synthesize existing literature on the mechanistic and therapeutic role of EVs in aging and age-associated disorders. METHODS:A comprehensive narrative review was performed utilizing Web of Science, Scopus, and PubMed databases. Studies assessing EVs in aging, cellular senescence, regenerative biology, and age-related disorders were included. Both preclinical and clinical studies were qualitatively examined, emphasizing EV origin, molecular pathways, and treatment outcomes. RESULTS:EVs derived from young or stem cells show strong antiaging features across multiple systems, such as the immune, musculoskeletal, cardiovascular, and nervous systems. These impacts are regulated via mitigating cellular senescence, reestablishing mitochondrial activity, restoring mitophagic and autophagic signaling, regulating inflammatory signaling, and improving tissue regeneration. Contrarily, EVs from diseases or aged cells improve pro-aging phenotypes, such as inflammation, fibrosis, and metabolic dysregulation, underscoring their context-mediated duality. Preclinical evidence consistently supports EV-mediated therapies; nonetheless, clinical translation remains restricted owing to heterogeneity in EV subpopulations, lack of standardized isolation protocols, and variability in bioactive payload. CONCLUSION:EVs represent promising therapeutic agents and biomarkers in aging biology, with the potential to regulate multiple hallmarks of aging concurrently. Prospective research should prioritize standardization, targeted bioengineering, and rigorous clinical validation to allow successful antiaging interventions.
OBJECTIVES:The association between tooth wear (TW) and dentin hypersensitivity (DH) is not well understood. This systematic review investigated the role of TW (and etiological factors) as an associated factor for DH. MATERIALS AND METHODS:Literature search was conducted in five databases with terms related to DH and TW, until April 2025. Three pairs of independent reviewers selected clinical studies reporting on DH and TW (and related etiology) in dentate adults, and performed data extraction. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. A structured narrative synthesis was performed. RESULTS:Twenty-one studies were included, with DH prevalence varying from 8.6% to 84.7%. Many indices were used for TW, the most common being BEWE (n = 8); and for DH, the most common being Schiff (n = 7). DH prevalence was higher in patients with (mean: 42.1%) versus without (18.7%) TW. Similar trends were observed when analyzing teeth with (34.6%) versus without (12.4%) TW. DH was associated with specific acidic diets, parafunctional behaviors, and health and lifestyle factors. There was conflicting evidence associating toothbrushing frequency and technique to DH. CONCLUSIONS:This review provides evidence for a consistent association between DH and TW and some etiological factors, observed across patient- and tooth-level analyses. CLINICAL RELEVANCE:Patients with TW and/or etiological factors-including dietary habits, oral hygiene practices, and parafunctional behaviors-should prompt a thorough evaluation for underlying DH, and vice-versa. Identifying and addressing these factors will help explain the occurrence of DH and guide effective prevention strategies.
OBJECTIVES:To update the evidence on the comparative effectiveness of self-applied dentifrices for the treatment of dentin hypersensitivity (DH) using systematic review and network meta-analysis methodology. MATERIALS AND METHODS:Randomized controlled trials evaluating self-applied dentifrices in adults with a diagnosis of DH were identified through literature searching of OvidSP versions of Medline, EMBASE and the Cochrane Library from November 2022-July 2025, supplemented by records obtained in a previous review and manual citation searching. Outcomes were assessed using validated measures including evaporative cold, tactile and thermal cold stimuli. Random-effects frequentist network meta-analyses were conducted for outcomes measured at 2 weeks. Risk of bias was assessed using the RoB 2 and certainty of evidence evaluated using the CINeMA framework. RESULTS:Ninety-three studies (9548 participants) were included, with 47 studies (4636 participants) contributing to the network meta-analyses. In consolidating findings across different outcome measurements we found stannous fluoride and arginine-based dentifrices consistently demonstrated the most clinically meaningful reductions in DH symptoms compared with a benchmark fluoride dentifrice across evaporative cold (Stannous Schiff MD -0.85 (95% CI -1.08; -0.62), high confidence rating; Arginine MD -0.78 (95% CI -1.02, -0.54), low confidence rating) and tactile (Stannous Yeaple MD 14.87 (95% CI 10.24, 19.50), moderate confidence rating; Arginine MD 9.78 (95% CI 4.69, 14.86), low confidence rating) outcomes. High-certainty evidence supported stannous fluoride for evaporative cold outcomes, while arginine demonstrated comparable effect sizes with lower certainty. Other formulations showed small to moderate effects with generally low certainty when compared with a benchmark fluoride dentifrice at 2 weeks. CONCLUSIONS:Stannous fluoride and arginine dentifrices should be considered first-line self-care options for DH. CLINICAL RELEVANCE:Clinicians can recommend the use of stannous fluoride or arginine dentifrices as first-line treatment for DH, with choice guided by patient preference, tolerability and availability rather than expectation of superior efficacy.
BACKGROUND:Surgical therapy is required in the majority of peri-implantitis cases due to the inconsistent efficacy of non-surgical approaches. Although surgical treatment generally offers higher predictability, reported success rates vary widely. AIM:To review the available evidence on the factors influencing the outcomes of peri-implantitis surgical therapy, including surgical technique, implant-site characteristics, and patient-related conditions. MATERIALS AND METHODS:This narrative review is based on a literature search conducted in three electronic databases to identify relevant studies published between January 2010 and November 2025. RESULTS:Surgical factors: The adjunctive use of reconstructive measures improves radiographic defect fill and may help maintain soft-tissue levels, although no clear benefits have been demonstrated in the resolution of clinical signs of inflammation compared with non-reconstructive approaches. Contained intrabony defects (3- and 4-wall) consistently demonstrate more favorable outcomes of reconstructive therapy compared with non-contained defects (1- and 2-wall). Reconstruction protocols that incorporate slowly resorbing bone substitutes may lead to more favorable outcomes compared with autogenous bone. No definitive conclusions could be made regarding the optimal flap design, postoperative healing mode (i.e., submerged versus non-submerged), or the benefits of adjunctive membranes, systemic antibiotics, or additional use of biologics. Overall, the effectiveness of surgical peri-implantitis treatment is associated with the surgeon's level of experience. Implant-site-related factors: Initial disease severity characterized by extensive bone loss, suppuration, deep probing depths, rough implant surfaces, and persistent bleeding after surgery have been identified as major factors compromising treatment success. Conversely, the presence of keratinized mucosa appears to enhance the outcomes of reconstructive peri-implantitis therapy. Emerging evidence points to an association between macrophage polarization and the outcomes of surgical peri-implantitis treatment. Patient-related factors: Current evidence underscores the essential role of patient adherence to supportive postoperative care in maintaining the results achieved surgically. Findings concerning the influence of a history of periodontitis, smoking status, and gender remain inconsistent. CONCLUSIONS:Outcomes of surgical peri-implantitis treatment are determined by a complex interplay of defect morphology, disease severity, implant surface characteristics, surgical expertise, and patient adherence to supportive care. CLINICAL RELEVANCE:Clinically, careful case selection, defect-specific surgical planning, and strict postoperative maintenance are essential to enhance predictability and long-term stability.
OBJECTIVES:To map omics evidence across peri-implant health, peri-implant mucositis, and peri-implantitis, and to identify recurring molecular patterns and candidate biomarker signals relevant to diagnosis, monitoring, and treatment. MATERIALS AND METHODS:This scoping review included human studies using genomics, DNA methylation-based epigenomics, bulk and single-cell transcriptomics, non-coding RNA analyses (including miRNA, lncRNA, and circRNA), proteomics, metabolomics, and microbiome profiling. Findings were organized by clinical state (health, mucositis, peri-implantitis) and interpreted within an implant-conditioned niche shaped by microbial, host, and biomaterial-related influences. RESULTS:Of 319 records identified, 78 studies were included. Most focused on genomics, transcriptomics, and the microbiome, with fewer studies in DNA methylation-based epigenomics, proteomics, and metabolomics. Peri-implant health was generally associated with oxygen-tolerant, biosynthetically active microbial communities and a regulated host-response baseline. Peri-implant mucositis appeared to be an intermediate plaque-induced state marked by expansion of bridge anaerobes and early innate inflammatory activation, but it was under-represented in transcriptomic, proteomic, and epigenomic datasets. Peri-implantitis was associated with stronger coupling between dysbiosis and host-destructive responses, including recurrent innate inflammatory hubs, chemokine-driven myeloid recruitment, protease activity, osteo-immune imbalance, and catabolic metabolomic profiles enriched in polyamines and short-chain fatty acids. DNA methylation studies linked disease status, and in limited cohorts, titanium particle burden, with altered methylation patterns. Non-coding RNA studies suggested additional regulatory networks related to inflammation and bone-associated signaling. Treatment studies indicated that decontamination may reduce bacterial biomass on rough titanium surfaces, but it does not consistently eliminate residual biofilm, suggesting biological improvements may reflect ecological shifts rather than complete surface decontamination. CONCLUSIONS:Current omics evidence suggests that peri-implant disease follows a staged, implant-conditioned biological trajectory rather than a simple binary healthy/diseased model.
BACKGROUND:Artificial intelligence (AI) is increasingly gaining attention in the field of periodontology and implant dentistry. Currently developed models can support diagnosis, treatment planning, and maintenance monitoring. However, most of the available literature is based on retrospective and often single-modality data sets. Therefore, they lack clinical generalizability and underrepresent the multimodal nature of periodontal and peri-implant diseases. OBJECTIVES AND METHODS:This study examines the current status of AI in the field of periodontology and implant dentistry and discusses the associated ethical and translational challenges. A narrative review search was conducted in PubMed, Embase, and Cochrane Library through February 2026. Furthermore, it explains the responsible implementation methods and proposes a roadmap for the sustainable adoption of AI in this field. RESULTS:The use of AI showed major promise in the field of periodontology and implantology. The main applications of AI in this field include bone loss detection, detection of intrabony defects, biofilm and microbiome-related analysis, patient communication, posttreatment monitoring, implant planning, detection of the implant system, and predicting the implant prognosis. Utilizing AI in these domains improved the efficiency, consistency, and access to care to some extent. However, there are major limitations that need to be addressed to move toward a responsible and sustainable use of AI. These limitations include reliance on single modality and single-center and nonshareable data sets, incomplete integration of clinical and biological variables, limited external validation, and persistent concern regarding bias, privacy, and explainability. These factors frame AI in periodontology as a clinician-supervised, data-dependent, and ethically guided technology rather than an isolated diagnostic tool. One of the most important factors that needs to be included in the training of clinicians is that they need to gain education on critiquing the AI outputs, use it as an assistive tool, and never over-rely on the AI outputs. The current evidence also suggests moving beyond the single-modality AI toward multimodal systems that better reflect the 2018 periodontal classification and the complexity of periodontal and peri-implant decision-making. CONCLUSION:Use of AI has substantially improved periodontology and implant dentistry research. However, a sustainable clinical translation requires responsible implementation of the AI and a stronger data set that represents the multimodal nature of the periodontal and peri-implant diseases. Moving forward, the data sets being used to train the models need to be multimodal, multicenter, and clinically verified to support the generalizability of the findings. In addition, there needs to be clear ethical safeguards and clinician oversight to make sure the results are interpreted in the correct way. CLINICAL RELEVANCE:As AI is becoming more prevalent among periodontists and other clinicians as an assistive tool, there is a clear need for proper education on how to use AI more effectively and responsibly. AI models and their outputs can be used for strengthening diagnosis, prognosis, treatment planning, and supportive care only when the full clinical context is provided. The long-term value of this integration of AI into clinical periodontology will largely depend on the following: whether it can be validated across diverse populations and whether it is supported by a shared clinical data infrastructure. This will ensure precise and consistent patient care in the real-world application of AI in the clinical setting.
AIM:This systematic review and meta-analysis aimed to compare soft and hard tissue outcomes of applying anatomic healing abutments (AHA) and provisional restorations (PR) versus cylindrical healing abutments (CHA) on immediately placed single implants. MATERIALS AND METHODS:Four databases (PubMed, Embase, Cochrane, and Web of Science) were searched on September 8, 2025, for two-armed studies comparing AHA/PR to CHA on immediate single-tooth implants. Outcomes included implant survival (IS), marginal bone loss (MBL), pink esthetic score (PES), patient satisfaction, as well as buccal bone and mucosal changes. Random-effects meta-analyses were performed. RESULTS:Twenty studies were included; 12 contributed to quantitative synthesis, showing no difference in IS (over 99% in all groups), MBL, or patient satisfaction. Pooled analysis of seven studies (340 implants) showed higher PES with AHA and PR than CHA group at 1 year (MD: 2.54; 95% CI: 1.12-3.96). Descriptive evidence suggested a trend toward improved horizontal tissue preservation with individualized healing. CONCLUSION:Within the limitations of this study, PR significantly improved PES without compromising IS or MBL. Their use may be beneficial, especially in the esthetic region, but further studies are needed to investigate their cost-effectiveness and long-term effect, especially on horizontal tissue changes. CLINICAL IMPLICATIONS:Anatomically shaped healing abutments and provisional restorations provide higher pink esthetics around immediately placed single implants, which is especially relevant for restorations in the anterior region.
BACKGROUND/AIM:Peri-implantitis is a plaque-associated disease characterized by inflammation of the peri-implant mucosa and progressive loss of supporting bone, representing a growing clinical and public health challenge. Conventional nonsurgical therapies often provide limited and unpredictable outcomes, while surgical approaches are associated with increased morbidity and variable long-term success. In this context, minimally invasive strategies, particularly flapless submucosal instrumentation, have emerged as a potential alternative or adjunct in the management of peri-implantitis. The aim of this narrative review is to critically appraise the contemporary evidence on flapless treatment approaches for peri-implantitis. MATERIALS AND METHODS:This narrative review analyzes the available literature on flapless submucosal instrumentation for peri-implantitis, presented as a minimally invasive access approach performed without flap elevation that combines submarginal instrumentation with deliberate peri-implant degranulation/curettage to improve access to the defect and implant surface, and may be considered in treatable, selected peri-implantitis cases within a stepwise care pathway. The biological rationale for flapless therapy is discussed based on the histopathological characteristics of peri-implant lesions, emphasizing the role of inflamed peri-implant soft tissues as a persistent reservoir of infection. Current mechanical, chemical, and adjunctive modalities employed within flapless protocols are reviewed. RESULTS:Clinical, radiographic, systemic, and patient-reported outcomes associated with flapless treatment approaches are examined. In addition, indications, limitations, and prognostic factors-including defect morphology, implant surface characteristics, prosthetic design, and patient-related risk factors-are analyzed. CONCLUSION:Although the available evidence remains heterogeneous and is largely derived from nonrandomized studies, flapless submucosal instrumentation appears to be a biologically sound and minimally invasive option for selected peri-implantitis cases, which may be repeated when clinically indicated while acknowledging heterogeneous protocols and limited comparative evidence. CLINICAL RELEVANCE:Flapless submucosal instrumentation may reduce the need for more extensive surgical interventions. Practical clinical recommendations and step-by-step treatment algorithms are proposed to support evidence-based and patient-centered decision-making in the management of peri-implantitis.
AIM:To critically summarize the current evidence on the role of the peri-implant soft tissue phenotype [specifically the width of keratinized peri-implant mucosa (KPIM) and the soft tissue thickness (STT)] and of the soft tissue grafting procedures used for the prevention and management of peri-implant diseases. MATERIALS AND METHODS:A narrative review of the literature was conducted, using PubMed for articles published up to December 2025, complemented by manual searching of reference lists. All different study designs were considered, prioritizing the highest available level of evidence. RESULTS:Peri-implant diseases are multifactorial biofilm-induced chronic inflammatory conditions. Their onset, progression, and response to treatment are influenced by the characteristics of the peri-implant soft tissues, which, unlike periodontal tissues, form a weaker biological seal, rendering them more susceptible to inflammation-driven tissue breakdown. A reduced width of KPIM is consistently associated with higher plaque accumulation, mucosal inflammation, discomfort during oral hygiene, and a greater prevalence of peri-implant diseases. It should be emphasized, however, that most of this evidence derives from cross-sectional and observational studies. KPIM augmentation procedures improve peri-implant soft tissue health and patient-reported outcomes, and STT augmentation by increasing mucosal thickness (MT) may enhance soft-tissue margin stability and reduce marginal bone loss. These benefits are best supported for surrogate outcomes, whereas the independent effect of soft tissue augmentation (STA) on the prevention of peri-implantitis remains less certain. In the treatment of peri-implantitis, there is some evidence that simultaneous or staged STA (particularly KPIM reconstruction) may improve clinical stability; however, its effect on disease resolution remains unclear, as most available studies lack a negative control group. CONCLUSIONS:Soft tissue grafting is a clinically relevant, phenotype-modifying strategy for preventing and managing peri-implant diseases. Risk-based, phenotype-driven decision-making (distinguishing KPIM augmentation from targeted STT augmentation) is essential for optimizing treatment outcomes.
OBJECTIVES:To make the case, from periodontology and dental public health, for interdisciplinary action on oral and systemic health, and to set out recommendations for practice, policy, education, and research. MATERIALS AND METHODS:A joint working group of the European Federation of Periodontology (EFP) and the European Association of Dental Public Health (EADPH), with public-health stakeholders and delegates from organized medicine (the World Heart Federation, WONCA Europe and the European Forum for Primary Care), synthesized the epidemiological, mechanistic, preventive and health-systems evidence, and developed consensus recommendations. RESULTS:Oral diseases affect around 3.5 billion people and share modifiable risk factors (free sugars, tobacco, and alcohol) and social and commercial determinants with the major non-communicable diseases (NCDs); inadequate oral hygiene is an additional oral-specific factor. This argues for integrating oral health into general health through a common risk factor approach rather than disease silos. Periodontitis has the strongest evidence for systemic interactions and, unusually among oral diseases, its treatment improves glycemic control in diabetes and inflammatory or vascular surrogates, though evidence for major clinical events remains limited; other links rest largely on shared risk factors and mechanisms (an asymmetry of evidence, not of public-health importance). Prevention and integrated care remain under-implemented. CONCLUSIONS:Oral health must be recognized as integral to general health and embedded within NCD strategies and universal health coverage through interprofessional, intersectoral action that also tackles the social and commercial determinants and reduces inequalities. CLINICAL RELEVANCE:Equipping all health and social-care professionals to promote oral self-care, screen and refer, and prioritize periodontal prevention and treatment, can improve both oral and systemic outcomes.
BACKGROUND:Periodontal and peri-implant diseases are multifactorial inflammatory conditions influenced by microbial, host, hormonal, genetic, and behavioral factors. Although sex-based differences in immune and inflammatory responses are well recognized in medicine, the extent to which biologic sex and hormonal status influence the prevalence, severity, and biologic markers of periodontal and peri-implant diseases remains unclear. OBJECTIVE:This narrative review synthesizes available human and animal evidence to evaluate whether sexual dimorphism exists in periodontal disease and peri-implant disease expression and to synthesize available evidence regarding hormonal status and biologic markers as potential modifying factors. METHODS:A comprehensive literature search was conducted to identify human and animal studies evaluating sex-associated differences in periodontal disease, peri-implant mucositis, and peri-implantitis. Sixty-eight human studies and 29 animal studies were included. Human studies encompassed epidemiologic, clinical, and biomarker-based investigations, while animal studies included direct male-female comparisons and female-only hormonal deficiency models. RESULTS:Most population-based human studies reported a higher prevalence or severity of periodontitis in males, characterized by greater clinical attachment loss and probing depths. However, several studies - particularly those involving adolescents - reported no sex differences, and a minority demonstrated female-predominant gingival inflammation, often in hormonally active life stages. In peri-implant disease, findings were largely inconsistent, with most studies reporting no significant association between biologic sex and peri-implantitis, while smaller subsets identified either male or female sex as a potential risk factor. Animal studies demonstrated heterogeneous sex-associated outcomes in direct male-female comparisons. In contrast, female-only estrogen-deficiency models consistently showed increased periodontal destruction and impaired peri-implant bone remodeling. CONCLUSION:Current evidence does not support uniform or universal sexual dimorphism in periodontal or peri-implant disease. Rather, the available literature remains heterogenous and largely exploratory, with observed differences varying according to hormonal status, age, inflammatory profile, and behavioral and environmental exposures. Across both human and animal studies, estrogen deficiency emerged as a consistent modifier of periodontal and peri-implant outcomes across species. Future studies incorporating prospective hormonal stratification, biologic-marker analysis, and large-scale epidemiologic datasets may help clarify multifaceted risk patterns.
Abstract Objectives To quantify long‐term (≥ 5 years) implant survival after lateral sinus floor elevation (LSFE) and to identify clinical predictors of long‐term survival using conventional and machine‐learning meta‐analytic techniques. Methods A systematic search was conducted through MEDLINE, Embase and Scopus. Randomized trials, prospective or retrospective studies with ≥ 10 patients and ≥ 5‐year follow‐up were eligible. Risk of bias was assessed with RoB‐2 (RCTs) and the Newcastle–Ottawa Scale (observational studies); certainty of evidence was graded with GRADE approach. A multilevel random‐effects meta‐analysis (logit‐transformed proportions) estimated pooled survival while accounting for clustering of multiple implants per patient. Moderator effects were explored by mixed‐effects meta‐regression. A MetaForest machine‐learning model examined non‐linear interactions among predictive factors. Results Thirty‐two studies (48 cohorts) involving 7,902 implants and ≈ 2,800 patients met the criteria (3 RCTs, 7 prospective non‐randomized, and 22 retrospective studies; follow‐up 5–13 years). Pooled long‐term survival was 95.8 % (95 % CI: 94.5–96.8 %); Heterogeneity was substantial (I² = 82.8 %) but fell to 53.2 % in MetaForest residuals. Meta‐regression identified lower survival with Graftless procedures versus allografts(β = 1.11, p = 0.016), autografts(β =2.40, p = 0.005), Xenografts(β =1.53, p = 0.04), Xenografts+Allografts(β =1.55, p = 0.04) and Xenografts+Autografts(β =1.82, p = 0.03) with no significant difference versus Alloplasts. Residual bone height (RBH) < 4 mm (β = –0.53, p = 0.039) as well as smoking prevalence (1.96 % per 10 % increase, p = 0.009) reduced survival. MetaForest ranked smoking, age, RBH, follow‐up duration and membrane use as the principal predictors; barrier membranes mitigated the negative effect in smokers and in low‐RBH sites. Time‐to‐failure analysis of 205 failed implants showed 59 % of losses within the first year and 96 % by year 5. Overall certainty of evidence was low. Conclusions Implants placed after LSFE exhibit high 5–13‐year survival (96 %). Use of bone graft materials and their mixtures yield more favorable outcomes compared to Graftless protocol, whereas RBH < 4 mm and smoking significantly impair implant survival. Barrier‐membrane coverage is advisable for smokers and short‐RBH sites. Despite the long‐term nature of this review (≥5 years of follow‐up), most failures occur within the first three years of function, underscoring the need for intensified monitoring during this early phase.
OBJECTIVES:Oral health's inextricable links to systemic health are highlighted by the emerging oral-gut-brain axis and other well-known axes. There is growing evidence of a complex oral-gut-brain axis linking mouth and gut microbiomes with the central nervous system. Axis disruptions, characterized as oral and gut dysbiosis or microbial imbalances, can trigger oral and systemic inflammation and neuroinflammation, contributing to diseases such as Alzheimer's disease and Parkinson's disease. MATERIALS AND METHODS:We summarize the oral-gut-brain axis mechanistic pathways, key evidence from human clinical and animal studies, and how the oral microbiome modulates human health and disease. RESULTS:Periodontal disease (PD) is associated with increased oral pathogen presence in diseased tissues throughout the human body. Preclinical models recapitulate these findings. Experimental periodontal infection induces dysbiosis that is linked to activation of inflammatory pathways that promote diseased phenotypes. Novel therapeutic approaches, including the probiotic bacteriocin nisin, are increasingly recognized for targeted microbiome therapy at multiple inflection points across the axis. Nisin restores microbial balance, reduces inflammation, inhibits end-organ pathology, prevents periodontal bone loss, and reduces brain amyloid/tau accumulation and cytokine expression. CONCLUSIONS:These findings highlight the complexity of the oral-gut-brain axis and the ability to modulate the axis using bacteriocin-based approaches. CLINICAL RELEVANCE:Future probiotic or antimicrobial strategies aimed at ameliorating neuroinflammatory and metabolic diseases via microbiome-targeted therapy hold clinical promise.
OBJECTIVES:Peri-implantitis is a common biological complication of dental implant therapy that affects peri-implant tissues as well as patients' psychological well-being and oral health-related quality of life. This review summarizes patient-centered perspectives on peri-implantitis, focusing on patient perception at diagnosis, treatment experiences, and treatment-related discomfort. MATERIALS AND METHODS:A narrative review of the literature was conducted to identify studies addressing patient perceptions, emotional responses, and patient-reported outcomes related to peri-implantitis management. Evidence from qualitative studies, cross-sectional investigations, and clinical trials reporting patient-centered outcomes was evaluated. RESULTS:The literature shows that peri-implantitis often progresses with minimal or no subjective symptoms, resulting in a discrepancy between clinical findings and patient awareness at diagnosis. Disclosure of the diagnosis is frequently associated with anxiety, stress, and concerns regarding implant prognosis and treatment burden. During treatment, patients commonly anticipate considerable pain and invasiveness; however, actual treatment-related discomfort is generally mild to moderate and transient, with postoperative pain peaking early and resolving within a short period. Patient experiences are strongly influenced by the clarity of diagnostic explanations, expectation management, and the quality of clinician-patient communication. CONCLUSIONS:Peri-implantitis has a measurable psychosocial impact beyond clinical parameters. Patient perceptions at diagnosis and during treatment play a key role in treatment acceptance and adherence. CLINICAL RELEVANCE:Many patients are diagnosed with peri-implantitis without prior awareness of the disease. Clear communication regarding diagnosis, expected treatment-related discomfort, and prognosis may reduce anxiety, improve treatment acceptance, and support long-term maintenance care.
OBJECTIVE:The aim of this systematic review and meta-analysis was to evaluate the longitudinal temporal pattern of periodontal probing depth (PPD) reduction in intrabony periodontal defects following non-surgical periodontal therapy (NSPT), both as a monotherapy and with adjunctive locally delivered pharmacological agents. MATERIALS AND METHODS:A comprehensive electronic search was performed in PubMed/MEDLINE and Embase databases to identify randomized controlled trials (RCTs). Eligible studies included adult patients with vertical defects treated with NSPT and reporting defect-level PPD values at predefined follow-up intervals (3, 6, 9, or 12 months). Pairwise temporal comparisons were conducted within treatment arms (6 vs. 3, 9 vs. 6, and 12 vs. 6 months) using standardized mean differences (SMD) in a random-effects model. Risk of bias was assessed with the Cochrane RoB 2 tool and certainty of evidence with GRADE. RESULTS:Eight RCTs met the inclusion criteria. Significant PPD reduction occurred between 3 and 6 months (SMD = -1.07; 95% CI -1.70 to -0.45, p < 0.001). Further significant improvements were detected between 6 and 9 months (SMD = -1.35; 95% CI -2.08 to -0.63) and sustained at 12 months compared to 6 months (SMD = -1.70; 95% CI -2.73 to -0.66). High heterogeneity was observed (I2 = 83-89%). Temporal PPD reduction across consecutive follow-up intervals was considered the primary outcome. Subgroup analyses suggested similar trends for both NSPT alone and adjunctive therapies. CONCLUSIONS:Clinical healing of intrabony defects after NSPT is a dynamic process extending up to 12 months, far beyond the traditional 3-months mark. Initial re-evaluation at 3 months primarily assesses inflammation control, whereas a 6-12 months window more accurately reflects definitive outcomes. CLINICAL RELEVANCE:Clinicians should exercise caution when scheduling surgical intervention for vertical defects. Delaying definitive decisions beyond 3 months for sites showing progressive improvement may avoid unnecessary surgical procedures and promote patient-centered outcomes through continued non-surgical maturation.
OBJECTIVES:The present systematic review critically summarizes the results of clinical studies investigating the risk of crown or root caries and tooth loss in adult patients suffering from periodontitis in relation to their adherence to supportive periodontal care (SPC). MATERIALS AND METHODS:Five electronic databases were searched for studies from 1947 to 2025. Odds ratios (or) were calculated for continuous outcome data (e.g., the number of new caries lesions or lost teeth) in a fixed or random-effects model. RESULTS:Thirty-nine articles, reporting 34 studies with 9685 patients at baseline with at least 157 779 teeth, were included. One study investigated the development of root caries at tooth level, 25 examined tooth loss at patient level, and 13 tooth loss at tooth level. A meta-analysis was not feasible for the outcome root caries. At patient level, significantly more less-adherent patients experienced tooth loss compared with adherent patients (OR = 1.50, 95% CI: 1.11-2.01). At tooth level, adherent patients showed significantly fewer lost teeth than less-adherent patients (OR = 1.64, 95% CI: 1.17-2.29). CONCLUSIONS:Adhering to SPC reduces the risk of tooth loss in periodontitis patients. In contrast, evidence on root caries prevention is limited, with only one study addressing this outcome. CLINICAL RELEVANCE:Prevention of caries and subsequent tooth loss is highly relevant for patients undergoing SPC. However, it remains insufficiently addressed in the current literature, underscoring the need for further well-designed studies investigating caries progression in periodontally compromised patients.
OBJECTIVES:To evaluate the clinical and radiographic efficacy of the adjunctive use of hyaluronic acid (HA) in regenerative periodontal surgery for the treatment of intrabony defects. MATERIALS AND METHODS:A systematic search identified randomized controlled trials (RCTs) involving adult patients with intrabony defects who underwent regenerative periodontal surgery with adjunctive HA. The primary outcome was probing pocket depth (PPD) reduction; secondary outcomes included clinical attachment level (CAL) gain, gingival recession (REC), and radiographic defect depth (RDD) reduction. Meta-analysis according to the regenerative protocol was performed using random-effects models, with subgroup analyses. RESULTS:Fourteen RCTs met the inclusion criteria. Compared to controls, adjunctive HA resulted in an additional PPD reduction of approximately 0.7-1.2 mm and CAL gain of 0.7-1.1 mm, with more consistent effects at 12 months. Subgroup analyses indicated significant benefits when HA was applied alone or with membranes, whereas no added benefit was observed with bone substitute materials. Radiographic outcomes showed a favorable trend for HA, with an additional RDD reduction of about 0.7-1.0 mm, though heterogeneity was noted. Comparisons between HA and enamel matrix derivative (EMD) revealed comparable or slightly superior results for EMD. CONCLUSION:Adjunctive HA may enhance clinical and radiographic outcomes in intrabony defects when used in regenerative periodontal surgery, although heterogeneity and study quality warrant cautious interpretation of the findings.
BACKGROUND:Coronally advanced flap (CAF), either alone or in combination with a connective tissue graft (CTG), represents one of the most extensively investigated surgical approaches for the treatment of gingival recessions, demonstrating high rates of mean root coverage (MRC) and complete root coverage (CRC). However, evidence regarding their long-term performance remains limited. AIM:This review critically analyzes the long-term clinical performance of CAF alone and in combination with CTG, examining root coverage outcomes, stability of the gingival margin, keratinized tissue (KT), and gingival thickness (GT) gain, and esthetic integration over extended follow-up periods. The influence of baseline phenotype, surgical modifications, and specific clinical scenarios on long-term success is explored. MATERIAL AND METHODS:A comprehensive narrative review of randomized clinical trials (RCTs), controlled studies, case series, and retrospective cohorts with a minimum follow-up of 5 years was conducted. Outcomes were stratified by surgical technique (CAF vs. CAF + CTG), defect complexity, and follow-up duration (5 to >20 years). RESULTS:CAF alone demonstrates satisfactory short-term coverage but exhibits gradual apical relapse over time, particularly in inadequate phenotype. Long-term studies indicate progressive reduction of CRC, with stability strongly linked to early gingival margin position and phenotype maturity. In contrast, CTG adjunctive therapy consistently enhances long-term stability by increasing KT and GT, improving resistance to mechanical and biological relapse. According to the authors' experience, CTG is especially beneficial in anatomically or etiologically complex conditions. Extended follow-up (>20 years) confirms the enduring role of CTG-driven phenotype modification in preventing marginal relapse. CONCLUSIONS:Long-term success in root coverage procedures is predominantly phenotype-dependent. While CAF alone may be appropriate in selected sites with favorable anatomical and phenotypic features, CAF + CTG remains the gold standard for securing stable outcomes over time, particularly in challenging clinical scenarios. The drawbacks of applying CTG must be considered alongside the treatment benefits. CLINICAL RELEVANCE:Future therapeutic algorithms should incorporate a phenotype- and defect-driven approach to optimize the lifetime stability of periodontal plastic surgery outcomes.
AIM:The high prevalence of peri-implantitis is concerning, with a growing consensus that the majority of cases are complications initiated by clinician-related errors rather than classic pathology. A primary predisposing factor for peri-implantitis is exposure of the micro-rough implant surfaces to the peri-implant sulcus after treatment. OBJECTIVES:To identify surgical/prosthetic factors causing micro-rough surface exposure and advocate for prevention and evidence-based protocols. MATERIALS AND METHODS:This paper reviews evidence linking surgical and prosthetic errors to micro-rough surface exposure to the sulcus and subsequent peri-implantitis development. RESULTS:Surgical factors for surface exposure include malposition, avascular necrosis, and incomplete bone regeneration of peri-implant defects. Prosthetic factors include cement remnants and wide prosthetic emergence angles. Clinician-influenceable co-factors-including patient compliance, history of periodontitis, uncontrolled systemic factors/habits, lack of keratinized mucosa, prosthetic misfit, overcontoured/uncleansable prostheses, failure to detect early bone loss or mucosal changes, and inadequate maintenance-contribute to the initiation and progression of peri-implantitis once micro-rough surfaces are exposed. CONCLUSIONS:Most peri-implantitis cases are preventable complications. Professional education and research must prioritize identifying clinician-related errors and adherence to foundational treatment principles. This requires a paradigm shift toward a complication-based model of peri-implantitis. CLINICAL RELEVANCE:To reduce the risk of peri-implantitis, clinicians should avoid clinical errors that lead to exposure of the micro-rough implant surface. Hybrid surface designs and subcrestal micro-rough surface placement should be considered as safety buffers. Success depends on meticulous diagnostics and planning, proper surgical/prosthetic execution, cleansable prosthesis design, and proactive maintenance to detect early bone loss and soft tissue changes.
BACKGROUND:Regenerative dentistry is shifting from cell-based strategies to cell-free biologics capable of orchestrating intricate tissue repair. Exosomes, nanosized extracellular vesicles carrying bioactive molecular payloads, have emerged as central modulators of intercellular communication. This review aimed to offer a comprehensive synthesis of exosome-based regenerative processes across oral and craniomaxillofacial (CMF) tissues. METHODS:A structured literature review was performed utilizing PubMed, Scopus, and Web of Science databases without time restriction. Eligible studies included in vitro, in vivo, and clinical investigations assessing exosome-based mechanisms, molecular signaling pathways, and bioengineering approaches in regenerative dentistry. RESULTS:Exosomes derived from stem cells, immune cells, and dental tissues showed multifaceted regenerative impacts across periodontal, endodontic, orthodontic, and CMF applications. Mechanistically, exosomes mediated osteogenesis, angiogenesis, immune regulation, oxidative stress, and stem cell recruitment through central pathways, such as the PI3K/AKT, MAPK/ERK, Wnt/β-catenin, TGF-β/BMP, and NF-κB. They enhanced macrophage polarization toward anti-inflammatory phenotypes, restored osteoclast-osteoblast homeostasis, enhanced angiogenesis, and preserved mitochondrial homeostasis. In regenerative endodontics, exosomes enhanced cell viability, decreased apoptosis, and improved odontogenic differentiation and neurovascular coupling. In orthodontic and CMF regeneration, they coordinated mechanotransduction, osteogenesis, and angiogenesis. Bioengineering approaches, such as scaffold-mediated platforms, preconditioning, and genetic modification, further improved exosome stability, targeting, and treatment efficacy. CONCLUSION:Exosomes represent a versatile and robust cell-free treatment approach capable of orchestrating intricate oral tissue regeneration. Despite promising preclinical evidence, challenges associated with standardization, scalability, and clinical validation must be addressed to allow translation in routine dental practice.
