This narrative review aims to critically appraise the scientific rationale, clinical indications, execution protocol, adjunctive therapies, and clinical outcomes of the flapless approach for the regenerative treatment of deep intrabony defects. This approach is contextualized within the broader framework of minimally invasive periodontal therapy. The flapless technique refines the minimally invasive paradigm by eliminating incisions, preserving soft tissue integrity, and enhancing clot stability. Emerging evidence suggests it can achieve clinical outcomes comparable to minimally invasive surgical techniques (MIST), with adjunctive enamel matrix derivatives (EMD) providing an additional benefit. Histological data remain limited, but clinical trials report significant gains in probing depth reduction, clinical attachment level, and soft tissue stability, particularly in esthetic areas. Nonetheless, the flapless approach remains technically demanding, requiring precise case selection and operator expertise. The flapless approach represents an evolution in minimally invasive periodontology, offering a site-specific, biologically respectful alternative for treating residual deep intrabony defects. When preceded by rigorous inflammation control and supported by biomimetic adjuncts, it provides favorable clinical and patient-reported outcomes with minimal morbidity. Nonetheless, long-term multicenter trials and histologic studies are needed to substantiate its regenerative potential and broaden its indications.

This study aimed to investigate the effect of enamel matrix derivatives (EMD) on the early healing biomarkers’ expression following flapless treatment. Thirty-eight patients with residual deep intrabony defects after steps 1 and 2 of periodontal therapy were randomly assigned to the test (flapless with EMD) or control group (flapless alone). Periodontal parameters were recorded at baseline and 6 months after treatment. Gingival crevicular fluid (GCF) was collected at baseline and 2 weeks after treatment to quantify the levels of biomarkers related to epithelial healing (epidermal growth factor, EGF), connective tissue healing (matrix metalloproteinase-8 [MMP-8], fibroblast growth factor [FGF], transforming growth factor-β [TGF-β]), and bone formation (osteoprotegerin [OPG]). The test group showed a significant reduction in MMP-8 levels (p = 0.039), along with significant increases in EGF (p < 0.01), FGF (p < 0.01), and OPG (p < 0.01). The control group demonstrated a significant decrease in MMP-8 (p = 0.010). No significant changes in TGF-β levels were observed in either group. At 6 months, the test group exhibited significantly greater reductions in probing pocket depth and clinical attachment level compared to the control group. This study is the first to characterize the biochemical changes following flapless treatment with EMD. These preliminary findings suggest that EMD may enhance early wound healing by modulating the expression of key regenerative biomarkers.

OBJECTIVES:The aim of this longitudinal intervention study was to assess the impact of psychosocial stress and coping response strategies on the clinical outcomes in periodontitis patients treated with non-surgical periodontal therapy (NSPT).MATERIALS AND METHODS:After the administration of psychological questionnaires, patients diagnosed with generalized stage III-IV periodontitis were categorized into different groups depending on their stress levels (10-item perceived stress level (PSS-10)) and coping response strategies (coping responses inventory (CRI)). Clinical data were collected 1 week before and 3 months after the completion of NSPT.RESULTS:Of the 90 patients included at baseline, 27 presented major and 63 minor stress levels, while 40 had avoidance and 50 approach coping behavior. All clinical parameters were similar at the baseline across different categories. At re-evaluation, full-mouth bleeding score (FMBS), mean probing pocket depth (PPD), and number of residual pathological pockets were significantly superior in groups with higher stress levels (p <0.001, p =0.001, and p =0.020, respectively), while higher full-mouth plaque scores (FMPS) and FMBS were found in patients with avoidance coping strategies (p =0.009 and p <0.001, respectively). When jointly evaluated, an added detrimental effect of coping styles on allostatic load was observed. Multivariate analysis confirmed a significant effect of stress levels and coping strategies on final FMBS, but not of coping on mean PPD.CONCLUSION:Psychosocial stress and avoidance coping strategy seem to negatively influence the clinical outcomes of NSPT at short term (NCT04739475; 9/1/2017).PRACTICAL IMPLICATIONS:Based on these findings, patients reflecting these psychological profiles should be considered at greater risk for poor NSPT response and may benefit from complementary stress management strategies.

Background Recent evidence is supporting the notion of a microbiological and immunological continuum on the gum-gut axis in health and disease. Therefore, the purpose of this study was to assess the prevalence and risk indicators of periodontitis in patients with Crohn's disease (CD) or ulcerative colitis (UC) compared to age- and sex-matched controls without inflammatory bowel disease (IBD). Methods A total of 180 IBD (117 CD, 60 UC, 3 IBD-unclassified) and 180 healthy controls were compared for their periodontitis diagnosis (Centers for Disease Control and Prevention/American Academy of Periodontology [CDC/AAP] case definition) and full-mouth periodontal parameters. In addition, explorative logistic regression models were performed. Results Significantly more patients with IBD had moderate/severe periodontitis (85.6% vs. 65.6%, p < 0.001) and severe periodontitis (36.7% vs. 25.6%, p < 0.001) than controls. Differences were higher in the 35-50 and 51-65 age groups, without significant changes between CD and UC. IBD subjects presented chances similar to 3.5 higher of having moderate/severe periodontitis (p < 0.001). Significant variables associated with periodontitis in the whole sample were older age, presence of IBD, and higher full-mouth plaque scores, whereas in the IBD group they were male sex, IBD-associated surgery, and IBD duration and localization (pancolitis). Positive risk indicators for IBD were periodontitis severity and higher bleeding scores, while smoking was negatively associated with UC. Conclusions Relevant associations between IBD and periodontitis were found, being modified by CD and UC clinical characteristics. Preventive and therapeutic strategies involving the gum-gut axis should be enforced in IBD patients.

Relevance.Aim – to assess the impact of psychosocial stress on the clinical outcomes in severe periodontitis patients treated with Nonsurgical Periodontal Therapy (NPT).Materials and methods.Patients received 2 psychological questionnaires to score their stress levels, while clinical data were obtained 1 week before and six weeks after the completion of NPT.Results.A total of 55 patients were consecutively included in the study and subsequently categorized into different stress levels (low stress level n = 22 and moderate/high stress level n = 33). All clinical parameters were found to be comparable at baseline between groups. While reduction in full-mouth bleeding scores was found to be statistically significantly lower in group with higher stress levels, a similar improvement in the other clinical parameters was observed at the completion of NPT.Conclusion.Psychosocial stress seems to influence negatively the results of NPT and highly stressed patients may represent a risk category for disease progression.