The objective of the study was to evaluate heat transfer within periodontal and periapical tissues when exposed to a 445 nm diode laser operating in continuous-wave (c.w.) versus pulsed mode. Mandibular bovine anterior teeth were endodontically prepared, and posterior teeth were used for laser-assisted periodontal therapy. A 445 nm diode laser was irradiated on root canals (120 μm glass fiber) and periodontal pockets (320 μm glass fiber) for 30 s (n = 20) at 2W in c.w. and pulsed modes (15 Hz, 50% duty cycle) using non-initiated tips. The maximum temperature changes (in °C) and heat transfer in height (vertical surface temperature distribution) and width (lateral heat transfer) were captured using a thermographic infrared camera. Mean periodontal heat temperature changes (in °C) were 36.53 ± 10.32 (c.w.) and 22.32 ± 8.46 (pulsed). In the periapical areas, the temperature changes were 11.65 ± 4.46 and 7.74 ± 2.40, respectively. In the periodontal tissues, lateral heat transfer was 6.13 ± 0.85 mm in c.w. mode and 6.94 ± 1.03 mm in pulsed mode. In the periapical areas, lateral heat transfer was 4.11 ± 0.75 mm in c.w. mode and 3.59 ± 0.32 mm in pulsed mode. The vertical surface temperature distribution in periodontal tissues showed similar patterns to periapical areas with minimal difference in both modes. Within the limitations of this study, a 445 nm diode laser caused a higher temperature change in continuous waves and produced greater lateral heat transfer than vertical spread in periodontal and endodontic applications. Received: 29 November 2025 | Revised: 28 February 2026 | Accepted: 25 March 2026 Conflicts of Interest The authors declare that they have no conflicts of interest to this work. Data Availability Statement Data sharing is not applicable to this article as no new data were created or analyzed in this study. Author Contribution Statement Grace Kang: Writing – original draft, Writing – review & editing, Visualization. Jamie Wu: Investigation. Ghaedsharafi Yasamin: Validation, Investigation. Jiayue Han: Writing – original draft, Writing – review & editing, Visualization. Thomas Manders: Validation, Investigation, Writing – review & editing. Rafael Delgado-Ruiz: Software, Validations, Formal analysis, Resources, Data curation, Writing – review & editing. Georgios E. Romanos: Conceptualization, Methodology, Validation, Investigation, Resources, Writing – review & editing, Visualization, Supervision, Project administration.

PURPOSE:To evaluate the presence of titanium (Ti) ions and particles after instrumentation of implant surfaces using different debridement methods in vitro. MATERIALS AND METHODS:Six debridement methods-including a stainless steel (SS) curette, Ti-curette, ultrasonic tip (CV), ultrasonic tip with plastic sleeve (CS), CO2-laser, and Er,Cr:YSGG (ECY) laser (WaterLase MD plus, Biolase)-were evaluated in this study. A simulated defect was created around an implant in a type 2 bone block, and irrigation was performed with water. For the laser groups, a CO2 laser (no contact, defocused beam, continuous wave, 2-W power) and an ECY laser tip were used (in contact with the implant; power of 2 W; 75 Hz; 40% water: 2% air). A total of 20 samples per method (120 samples total) were collected using paper points after 30 seconds of instrumentation. Chemical composition analysis of the bone block, water irrigation, and instruments (before the study [baseline]) were evaluated for the presence of Ti ions and particles via liquid samples after instrumentation with an X-ray fluorescence spectrometer. Statistical analysis using sample t test was performed for each debridement method. RESULTS:Baseline measurements showed no Ti ions or particles. However, Ti ions and particles were found in the groups using SS curettes, CV ultrasonic inserts, and Ti curettes, with values of 0.0232 ± 0.0181 ppm, 0.0047 ± 0.0042 ppm, and 0.0072 ± 0.0037 ppm, respectively. Ti ions and particles were not observed in the CS ultrasonic insert group or either laser group. The semiquantitative data showed a higher presence of Ti ions and particles in the groups that used SS curettes, Ti curettes, and CV ultrasonic inserts in comparison to baseline (P < .0001). CONCLUSIONS:Ti ions and particles were found after instrumentation using SS curettes, Ti curettes, and CV ultrasonic inserts, which may affect the disease etiology and outcomes of peri-implantitis therapy more prominently compared to irradiation methods such as CS ultrasonic inserts, CO2 lasers, or ECY lasers.

PURPOSE:To compare survival and clinical performance of zirconia versus titanium dental implants, with meta-analyses stratified by follow-up period and, where feasible, by study design. MATERIALS AND METHODS:This PRISMA-compliant review was registered in PROSPERO (XXXX). MEDLINE, Embase, Scopus, CENTRAL, and Web of Science (until May 2025), along with citation tracking, were searched for comparative human studies. The primary outcome was marginal bone loss (MBL); secondary outcomes were implant survival, probing depth (PD), keratinized tissue width (KTW), Pink Esthetic Score (PES), and patient-reported outcomes (PROMs). Random-effects models were used (Hartung-Knapp); heterogeneity was assessed with I²/Q. Subgroups contrasted one-piece versus two-piece zirconia implants. Prespecified sensitivity analyses included risk-of-bias restriction and leave-one-out influence checks. Publication bias and meta-regression analyses were not undertaken (<10 studies per outcome). RESULTS:Nine studies (six randomized controlled trials, two prospective cohorts, and one cross-sectional) involving 323 patients and 435 implants (222 zirconia and 213 titanium) met the inclusion criteria. Outcome-specific meta-analyses utilized only studies reporting the relevant endpoint (typically 2-6 studies at 1 year and 2-4 studies at ≥5 years). At 1 year, RCTs showed no difference in survival (risk ratio [RR]:0.98; 95% CI: 0.94-1.01; I²=0%). In contrast, observational cohorts were imprecise and heterogeneous (RR 0.78; 0.24-2.57; I²=91.9%). Five RCTs indicated slightly greater MBL around zirconia (mean difference [MD] 0.16 mm; 0.02-0.29; I²=0%), whereas two observational studies suggested a non-significant opposite trend (MD 0.11 mm; -0.73 to 0.51). No significant differences were observed for PD, KTW, PES, or PROMs (2-4 studies per outcome). Subgroup analysis suggested a potential difference in 1-year survival for two piece zirconia (RR 0.94; 0.91-0.97; I²=0%), while one-piece showed no difference (RR 0.99; 0.94-1.03; p<0.001 for subgroup difference). At 3 years, survival did not differ (RR 0.93; 0.86-1.01; I²=0%). At ≥5 years, survival (RR 0.99; 0.91-1.08; I²=0%) and MBL (MD -0.03 mm; -0.14 to 0.08; I²=0%) were comparable; PD slightly favored zirconia (MD 0.29 mm; -0.55 to -0.02; I²=0%), while PES showed no difference. Sensitivity analyses confirmed robustness for ≥5-year outcomes, although the 1-year MBL effect was attenuated after risk-of-bias restriction. CONCLUSIONS:In healthy patients, zirconia and titanium implants demonstrate comparable clinical and radiological outcomes over a follow-up period of up to five years. Evidence remains insufficient regarding long-term outcome for zirconia implants, and part of the available data is based on legacy systems that are no longer on the market.

In the oral environment, silicone (polysiloxane) supports healing by creating low-permeability interfaces that limit microleakage, whereas silicon/silica systems support healing via hydroxyapatite nucleation. We synthesized human evidence on intraoral healing associated with silicone and silicon/silica-based materials and assessed translational differences between preclinical models and clinical settings. A systematic review (1990-September 2025) identified 14 clinical studies of bioactive glass (BAG) that met the inclusion criteria. Periodontal outcomes included probing depth (PD), clinical attachment level (CAL), and radiographic fill; endodontic outcomes included the periapical index (PAI). Human BAG studies showed periodontal benefits versus controls in intrabony defects, with reduced PD, improved CAL, and greater radiographic fill. For endodontic healing, a multicenter randomized clinical trial reported improved PAI at 12 months in both the zinc-oxide-eugenol and silicone-sealer groups without a significant between-group difference. The literature supports a functional split: silicone primarily provides sealing and permissive healing, whereas silicon/silica-based materials support signaling, interfacial bonding, and regenerative healing. Clinically, BAG appears most relevant for contained periodontal intrabony defects, whereas silicone sealers should be viewed primarily as stable sealing adjuncts to well-executed root canal therapy.

PURPOSE:To investigate the remodeling process of hard tissue components in fresh extraction sockets that underwent natural healing followed by localized alveolar split-crest surgery for implant placement. MATERIALS AND METHODS:Patients with bone defects in the maxillary esthetic zone, characterized by decreased mineral density around the affected tooth were treated via socket healing without bone substitutes, delayed alveolar splitting, and subsequent implant placement. Preoperative (baseline: before the stage-one and stage-two surgeries) and postoperative CBCT scans were analyzed to assess changes in bone volume and crestal width. Statistical analysis was performed using nonparametric tests, with a significance level set at P < .05. RESULTS:A total of 13 incisors were retrospectively evaluated. No major postoperative adverse events were recorded. After 2 years, the implants achieved a 100% survival rate. No episodes of peri-implant mucositis or peri-implantitis were reported. Radiographs taken 3 months after tooth extraction revealed bone mineralization without the use of bone substitutes; however, the volume was insufficient for immediate implant placement. Following tooth extraction, the split procedure, and implant placement (stage-one and stage-two surgeries), total bone volume showed a significant increase (P = .0105) from baseline (919 ± 179 mm3) to the 2-year follow-up (955 ± 176 mm3). Similarly, crestal width demonstrated a significant increase (P = .0012), increasing from 6.1 ± 2.7 mm at baseline to 7.5 ± 2.0 mm at 2 years, with a mean gain of 1.4 ± 1.0 mm due to the split-crest procedure. CONCLUSIONS:After 2 years, the results indicated that natural healing of the extraction socket without the use of bone substitutes, followed by delayed localized alveolar splitting, led to a significant increase in bone volume and preservation of the outermost alveolar bone layer. The observed postextraction site augmentation was concentrated in the esthetic zone.

Benign paroxysmal positional vertigo (BPPV) is a common inner ear disorder characterized by intense dizziness often triggered by sudden head movements. Certain dental and maxillofacial surgeries may induce BPPV due to vibrational trauma from instrumentation, extended hyperflexion of the head, and existing vestibular conditions. This study aimed to analyze certain oral and maxillofacial surgical procedures associated with BPPV and evaluate prevention and treatment strategies. A review of relevant literature was conducted through Google Scholar and an extensive search on PubMed for the period 2005-2020 using the keywords "BPPV" and "benign paroxysmal positional vertigo." Articles were screened up to the 2564th listing, focusing on cases of postsurgical BPPV. Eight studies were included and analyzed, including case reports, retrospective analyses, and literature reviews. The procedures that led to BPPV in these studies include sinus floor elevation, maxillary implant placement, third molar extractions, and orthognathic surgery. Factors that contributed to the development of BPPV include surgical trauma, use of osteotomes, abnormal head positioning, and preexisting vestibular conditions. Although postoperative BPPV is typically self-limiting, treatment may involve physical rehabilitation (Epley maneuver) or pharmacotherapy (benzodiazepines, antihistamines). Analysis of the studies revealed that treatment considerations may include referral to an ear, nose, and throat practitioner for management; careful review of the patient's medical history; proper patient positioning; and cautious use of osteotomes. Although BPPV is a rare complication, surgeons should be aware of its potential implications to mitigate unnecessary development of BPPV and management of the condition. Further research is needed on the optimal prevention, treatment, and patient management strategies.

OBJECTIVE:Gingival excess, also referred to as excessive gingival display (EGD), represents a multifactorial esthetic concern influenced by skeletal, dental, and soft tissue factors. Conventional orthodontic or orthognathic interventions, while effective, may present increased morbidity. This prospective case series evaluates a minimally invasive, interdisciplinary approach integrating periodontal and cosmetic techniques for managing multifactorial gingival excess. CLINICAL CONSIDERATIONS:Twelve systemically healthy adult patients (mean gingival display: 5.3 mm) diagnosed with both altered passive eruption and hyperactive upper lip were treated in a private practice using a combined single-session protocol. The "combo technique" involved esthetic crown lengthening, botulinum toxin-A (Botox) injections, and hyaluronic acid-based lip augmentation. Diagnosis and treatment planning were based on comprehensive clinical and radiographic assessments. Outcome measures included gingival display reduction, patient satisfaction, and postoperative discomfort, evaluated at 6 and 18 months. CONCLUSIONS:The integrated "combo technique" offers a minimally invasive and highly effective alternative for correcting EGD. It enables individualized treatment planning, reduces the amount of Botox needed, and results in stable esthetic outcomes with high patient satisfaction and minimal postoperative discomfort. This interdisciplinary approach provides a predictable and long-lasting solution for complex GS cases in patients unwilling or unsuitable for orthognathic surgery.

PURPOSE:To evaluate the primary stability of short implants vs conventional implants in vitro. MATERIALS AND METHODS:Two groups of implants, short implants (6.0 × 7 mm) and conventional implants (3.75 × 10 mm), with a reverse concave neck and neck microthreads (ULT, Ditron Dental) were studied. A total of 80 implants (40 short implants and 40 conventional implants) were placed by the same calibrated clinician (G.R.) at 800 rpm. Each implant was placed in hard (type 2) and soft (type 4) bone. Implant primary stability was recorded using insertion torque (IT), resonance frequency analysis (RFA), and Periotest values (PTVs). Statistical comparison with one-way analysis of variance (ANOVA) were completed to compare differences between groups. RESULTS:The comparison of IT and RFA values and PTVs of the two implant groups showed statistical significance (P < .0001) favoring the short implants in both the soft and hard bone qualities. CONCLUSIONS:Within the limitations of this study, short implants with a wide diameter seem to have a higher level of implant stability compared to narrow implants with a conventional length.

PURPOSE:To evaluate the importance of clinical expertise on implant stability (IS) of 6-mm implants placed in vitro. MATERIALS AND METHODS:A total of 480 implants (Tapered Short Implants, BioHorizons) (6-mm length and diameters of 4.6 mm and 5.8 mm) were used in this study. All implants were placed by three clinicians with different surgical experience levels: one master clinician (G.E.R.), one third-year resident with experience with nearly 100 implants (A.Z.), and one resident without implant surgical experience (N.E.E.). Each clinician placed 40 implants of each diameter (4.6 mm and 5.8 mm) in type 1 bone (dense) and 40 implants of each diameter in type 4 bone (soft; Sawbones), resulting in a total of 160 implants per clinician. Additionally, within each bone type, half of the implants (20 per diameter) were placed at bone level (crestal level), while the other half were placed 1 mm above the bone crest (supracrestal). The IS was evaluated using an Osstell device. Comparison of IS between all three clinicians for all implant groups was performed using oneway analysis of variance (ANOVA) and Bonferroni correction for multiple comparisons regarding the significance level, which was set at P < .05. RESULTS:Implants placed supracrestally showed differences between the experienced and inexperienced clinicians but not between the master clinician and third-year resident. A similar trend can be observed with implants placed at crestal levels. In type 1 bone, greater stability was achieved for the experienced clinicians when compared to the inexperienced one (P < .0001); however, in type 4 bone, the comparison of stability showed a P value < .0001 for all groups, with greater IS values for the master clinician over both residents. CONCLUSIONS:Overall, both the master and moderately experienced surgeons presented increased stability on 6-mm implants compared to the inexperienced resident.

Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication associated with antiresorptive and antiangiogenic therapies. Laser-based approaches, including photobiomodulation therapy (PBMT) and erbium laser-assisted surgery, have been proposed as adjunctive interventions to improve healing and clinical outcomes. This consensus-based review aimed to synthesize evidence from systematic reviews and meta-analyses evaluating laser-based therapies in the prevention and treatment of MRONJ, and to translate these findings into clinical recommendations developed by the World Federation for Laser Dentistry (WFLD) and the Polish Society for Laser Dentistry (PTSL).The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and Joanna Briggs Institute (JBI) guidance, and was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO). An electronic search of the PubMed/MEDLINE, Embase, Scopus, and Cochrane Library databases was conducted for systematic reviews and meta-analyses published between January 2015 and October 2025. Study selection, data extraction and methodological assessment were performed independently by 3 reviewers.Eighty-five records were identified, and 14 reviews met the inclusion criteria. These included several hundred primary studies, mainly observational studies and case series. Laser-based interventions were primarily used as adjuncts to conventional MRONJ management. Photobiomodulation therapy was associated with pain reduction and improved soft tissue healing, while erbium-doped yttrium aluminum garnet (Er:YAG) laser-assisted surgery enabled the precise removal of necrotic bone. Combined protocols showed generally favorable trends. However, substantial heterogeneity in study design, laser parameters and outcome definitions precluded quantitative synthesis.Laser-based therapies may provide beneficial adjunctive effects in MRONJ management, particularly within multimodal treatment strategies. However, the strength of these conclusions is limited due to substantial heterogeneity in study design, laser protocols and outcome reporting.

The sinus lift procedure, first introduced in the 1970s to address insufficient bone height in the posterior maxilla for dental implants, has greatly evolved over the years. Traditional invasive techniques, such as the lateral window approach, posed a high risk of complications, including membrane perforation. Recent developments have led to the creation of the hydraulic sinus lift, introduced in 2005, which uses hydraulic pressure to gently lift the sinus membrane, lowering risks and increasing precision. Studies have shown its high success rates, minimal postoperative discomfort, and improved surgical outcomes. Innovations such as the crestal approach sinus kit have further improved the technique, allowing better control, faster surgeries, and improved implant stability. This review traces the history of sinus lift methods, focusing on hydraulic techniques, and discusses potential future improvements in tools and materials. As technology advances, these innovations are set to make sinus lift procedures safer, more effective, and more efficient, leading to better results for patients needing dental implants.

Maxillary atrophy is relatively common among long-term edentulous patients, especially in older adults. Severe forms, although less prevalent, are still frequently encountered in implant and prosthodontic practice, particularly in patients who have been without teeth for many years or who have worn poorly fitting dentures. This case report presents the treatment of a 77-year-old female smoker who had been missing her teeth for 22 years and had a non-functional prosthesis. The article describes the vertical and horizontal gain in the patient's edentulous maxilla utilizing allograft customized bone blocks to extensively augment the amount of bone. Upon review of a CBCT scan taken after 6 months, the bone gain was evident, revealing a ridge width of between 6.9 mm and 8.9 mm and confirming that the outcome matched the design of the allograft customized bone block. The allograft customized bone block treatment showed itself to be a potential alternative to extensive bone harvesting procedures for treating and augmenting a severely atrophic maxilla while yielding decreased donor site complications and postoperative issues.

Background/Objectives: The aim of this study was to investigate primary colonizers adhering to the oral biofilm on five adhesive restorative materials. Methods: For each material (Admira Fusion, Clearfil AP-X, Durafill VS, Filtek Supreme XTE, and Venus Diamond), sixteen test specimens were prepared according to a standardized protocol. For pellicle formation, the specimens were incubated for two hours at 37 °C with sterile-filtered inactivated human saliva. The bacteria (Streptococcus oralis (S. oralis), Streptococcus gordonii (S. gordonii), Streptococcus sanguinis (S. sanguinis), Streptococcus mitis (S. mitis), and Actinomyces naeslundii (A. naeslundii)) were cultivated and suspended. A bacteria mix was prepared from the suspensions. The specimens with pellicles were wetted with the bacterial mix and incubated at 37 °C for 8 h. The total genomic DNA of the adhered bacteria was isolated and subsequently quantified using SYBR Green qPCR. Results: For S. gordonii, S. oralis, and A. spp., no significant differences in the amount of adhered bacterial DNA were found between the different materials. S. mitis DNA concentration was significantly higher on Filtek Supreme XTE compared to the other materials. Significantly higher DNA concentrations of S. sanguinis could also be detected on Filtek Supreme XTE compared to Clearfil AP-AX and Durafill VS. Conclusions: The investigated restorative materials showed species-specific differences in bacterial adhesion, with Filtek Supreme XTE exhibiting higher adhesion of S. mitis and S. sanguinis, whereas no differences were observed for the other tested species.

Background: With an increasing demand for aesthetic treatments, tooth bleaching is becoming a common procedure. Thus, a range of bleaching products are nowadays available at the market. As it is important to consider adverse effects on surrounding soft tissue, the paper aims at evaluating possible cytotoxic effects on fibroblasts in vitro. Respectively, commonly used gingiva barriers should also be critically examined regarding biocompability. Methods: Seven At-Home bleaching products (Opalescence 10/ 15/ 20, Perfect Bleach 10, Perfect Bleach 16, Viva Style 16 and White Strips), two In-Office products (Easy White Ready Kit and Opalescence Quick) and two gingiva barrier products (Easydam and Opaldam) were used for cytotoxic evaluation on primary human fibroblasts after 48h. Quantitative evaluation was performed using a cell counter for cell viability and qualitative evaluation was performed using cytotoxic grading based on morphological assessment according to ISO 10993-5. Results: There were no significant differences regarding viable cells between At-Home and In-Office bleaching products nor between gingiva barriers and the cell control. All In-Office bleaching products and three At-Home products (Opalescence 15 and 20 and Perfect Bleach 16) showed significant fewer viable cells than the cell control. Based on the qualitative assessment, the same bleaching products, except for Perfect Bleach 16, could be categorized as cytotoxic according to ISO 10993-5. Conclusions: Cytotoxic effects could be observed within At-Home and In-Office bleaching products by qualitative and/or quantitative means. Gingiva barriers showed no cytotoxic effects and their use as part of bleaching treatments seems to be beneficial for protecting the surrounding soft tissue.

Background/Objectives: Long-term clinical data on direct posterior composite restorations are scarce, particularly beyond simple survival outcomes. This study aimed to characterize the long-term functional, esthetic, and biological behavior of posterior composite restorations after nearly three decades of service using selected FDI criteria and to assess changes across available follow-up examinations, including within a predefined sub-cohort. Methods: This observational follow-up involved 21 patients with 57 posterior composite restorations placed in 1995-1996 at the Department of Operative Dentistry, Goethe University Frankfurt, by undergraduate dental students under supervision. The 2025 follow-up used FDI criteria to assess functional, aesthetic, and biological properties, classifying outcomes as clinically acceptable, intervention needed, or failure. Descriptive analyses were applied to the entire cohort. Longitudinal analyses were conducted on a sub-cohort of 14 patients with 27 restorations at three time points. Exploratory analyses assessed associations with restoration factors, caries experience, and gingival health. Results: In 2025, 54.4% of restorations were clinically acceptable, 28.1% required intervention, and 17.5% were failures. Functional criteria remained mostly acceptable, though form and contour showed the highest mean values. In the longitudinal sub-cohort, significant changes over time were observed in anatomical form and occlusal wear. Retention, marginal adaptation, proximal contact, and surface luster did not change significantly. Biologically, restorations available for direct assessment had low incidences of secondary caries, hard-tissue defects, and postoperative sensitivity or pulpal issues. Conclusions: Posterior composite restorations can function for nearly three decades but gradually deteriorate in certain aspects. Long-term changes mainly involve cumulative functional aging of the anatomical form and occlusal wear, rather than widespread biological failure. These findings underline the importance of differentiated long-term assessment and support conservative management approaches where clinically feasible before replacement is undertaken.

Objectives: Six dentin adhesives were tested in vitro regarding their cytotoxicity toward human fibroblasts. AdheSE, Clearfil SE Bond, Hybrid Bond, One-up Bond F Plus, Optibond Solo Plus, and Syntac were tested using a cell culture model. The several components of dentin adhesives, like the primer and bonding, were analyzed as single and additive applied components as specified by the manufacturer for application in vivo. Methods: Seventy-five Petri dishes were produced per adhesive and control group, and all 525 Petri dishes were evaluated using multiparametric strategies, i.e., using multiple methods to strengthen the reliability of the results. The multiparametric strategies consisted of automated cell counting for viability, microscopic morphological assessment and lastly of reactivity grading according to ISO 10993-5. These assessments were performed after our initial investigation, and the observation period was extended from 24 h to 48 h. Results: AdheSE, Clearfil SE Bond, One-up Bond F Plus, and Optibond Solo Plus showed statistically significant reductions in viable cells relative to the cell control. All dentin adhesives except Clearfil SE Bond showed a statistically significant difference regarding the reactivity index in the application comparison. Conclusions: The test materials showed a moderate degree of cytotoxicity, with no statistically significant difference between the tested self-etch and etch-and-rinse dentin adhesives. However, the results show statistically significant differences between the adhesives when applied sequentially and once. Further research addressing mechanisms of cytotoxicity is needed for advancement in this field.

Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a significant challenge for clinicians with limited treatment options. In this case series, a CO2 laser (9.3µm) was utilized in conjunction with platelet-rich fibrin (PRF) mixed with allograft to create sticky Bone. Materials & Methods: Four consecutive patients with MRONJ at implant sites were treated at a private practice setting. The necrotic bone was removed, and the sites were irradiated with a CO2 laser and ethelylenediaminetetraacetate (EDTA). Platelet-rich fibrin (PRF) mixed with BioOss Collagen particulate to create sticky bone to graft in the defect sites and secured with a solid-PRF membrane. Herbal-based mouthrinses in place of chlorehexidine was utilized as a post-surgical rinse. Follow-up time for the cases ranged from 6 months to 7 years. Results: All patients healed uneventfully without any post-operative complications. In one case, a new implant was placed without any post-operative complications with a 2-year follow-up. Conclusion: This case series demonstrates successful outcomes of treating MRONJ at implant sites utilizing CO2 laser to decontaminate the implant surface and sticky bone for regenerative therapy. Additional controlled clinical studies are necessary to validate this technique.

The aim of this study was to investigate the adhesion of primary colonizers of the oral biofilm on five adhesive restorative materials. For each material (Admira Fusion, Clearfil AP-X, Durafill VS, Filtek Supreme XTE, Venus Diamond) sixteen test specimens were prepared according to a standardized protocol. For pellicle formation, the specimens were incubated for two hours at 37 °C with sterile-filtered inactivated human saliva. The bacteria (S. oralis, S. gordonii, S. sanguinis, S. mitis, A. spp.) were cultivated and suspended. A bacteria mix was prepared from the suspensions. The specimens with pellicles were wetted with the bacterial mix and incubated at 37 °C for 8 hours. The total genomic DNA of the adhered bacteria was isolated and subsequently quantified using SYBR Green qPCR. For S. gordonii, S. oralis and A. spp., no significant differences in the amount of adhered bacterial DNA were found between the different materials. DNA concentration of S. mitis was significantly higher on Filtek Supreme XTE compared to the other materials. Significantly higher DNA concentrations of S.sanguinis could also be detected on Filtek Supreme XTE compared to Clearfil AP-AX and Durafill VS.

INTRODUCTION/OBJECTIVES:The treatment of peri-implantitis remains one of the most challenging areas in implant dentistry, with no universally accepted gold standards for long-term disease resolution. As the prevalence of peri-implantitis continues to rise with increased implant placement, the need for predictable and effective therapies becomes increasingly critical. Laser-assisted treatment has emerged as a promising modality in surgical and non-surgical management of peri-implant diseases due to its ability to decontaminate the implant surface, reduce the bacterial load, and debride bone defects. DATA/SOURCES:An electronic search utilizing terms related to "peri-implantitis" and "dental lasers" was conducted via PubMed and Google scholar with a focus on highly cited articles based on inclusion and exclusion criteria, and review articles as well as the authors personal experiences. This review does not follow PRISMA guidelines or include risk-of-bias analysis due to its narrative format. The aim of the present investigation was to analyze the current available literature on laser therapy in the treatment of peri-implantitis, with a focus on how clinical outcomes vary according to laser type, wavelength, power settings, and the use of adjunctive phototherapies such as photodynamic therapy (PDT) and photobiomodulation (PBM). CONCLUSIONS:While there is significant limitation in the clinical evidence available, thus far the literature suggests potential use of Erbium and CO2 wavelengths as an adjunct in peri-implantitis therapy, while the existing evidence against the use of the Nd:YAG-laser on implant surfaces. The evidence is inconclusive regarding the use of diode lasers including photodynamic therapy (PDT) and Photobiomodulation (PBM), and as the field of dental lasers continues to develop, specific power settings and standardized protocols will emerge and continuously improve. CLINICAL SIGNIFICANCE:The paper demonstrates possibilities of phototherapy in the treatment of peri-implantitis and highlights opportunities of treatment based on the limitations of available evidence with mechanisms for each laser wavelength and their interactions with the peri-implant tissues.