Periodontology 2000[JOURNAL]
Sun
200 papers
Efficacy of adjunctive use of hyaluronic acid in surgical and nonsurgical periodontal treatment. A systematic review and meta-analysis.
Rotundo R, Coccoluto L, Nieri M … +4 more , Marini L, Pilloni A, Sculean A, Mainas G
Periodontol 2000 · 2026 Apr · PMID 41992778 · Publisher ↗
BACKGROUND: High interest has been recently shown toward the use of hyaluronic acid (HA) gel as adjuvant to nonsurgical but also to surgical periodontal therapy. AIM: To update the knowledge on the potential clinical eff...
BACKGROUND: High interest has been recently shown toward the use of hyaluronic acid (HA) gel as adjuvant to nonsurgical but also to surgical periodontal therapy. AIM: To update the knowledge on the potential clinical effects of HA when used in conjunction with nonsurgical and surgical (both regenerative and mucogingival) periodontal therapy by applying the latest Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. MATERIALS AND METHODS: Three different PICOS frameworks were used to guide the inclusion of eligible studies dealing with the adjunctive application of HA in nonsurgical, surgical periodontal therapy, and in root coverage procedures. The following variables were considered: clinical attachment level gain (CALgain), pocket depth reduction (PPDred), recession reduction, pocket closure (for nonsurgical), bleeding score (for nonsurgical), bone gain (for surgical and nonsurgical), percentage of root coverage (%RC, for root coverage procedures). A detailed systematic search was conducted in the following targeted electronic databases: Medline via Pubmed, EMBASE, Cochrane Database of Systematic Reviews and Scielo. Studies were grouped into three predefined analytical strata corresponding to nonsurgical therapy, surgical periodontal therapy, and mucogingival procedures, allowing separate meta-analyses tailored to each clinical scenario. Risk of Bias assessment was performed by using the RoB 2.0 Tool and the overall strength of the available evidence was determined by using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. RESULTS: From 1554 records, 31 studies were included in the systematic review, but only 20 were eligible for meta-analysis. In nonsurgical periodontal therapy, the adjunctive application of HA showed an overall statistically significant improvement in terms of CALgain (difference of 0.72 mm, 15 studies), PPDred (difference of 0.57 mm, 16 studies), and bone gain (difference of 0.56 mm, 2 studies). However, when only studies at low risk of bias were considered, the statistically significant difference was not confirmed. No statistically significant differences were observed for recession reduction, pocket closure and bleeding score. In surgical periodontal therapy, two studies suggested greater CALgain (difference of 1.36 mm, 2 studies) and PPDred (difference of 1.03 mm, 2 studies) with adjunctive HA, though both trials were at unclear risk of bias. For mucogingival procedures, two studies showed a modest increase in %RC RC (difference of 15.29%, 2 studies), while no benefit was found for other clinical parameters. CONCLUSIONS: Within its limitations, the present analysis shows that the adjunctive use of HA produces variable clinical effects across periodontal therapies. Small improvements are observed in nonsurgical treatment, and limited data suggest a potentially favorable effect in periodontal healing. Overall, the current evidence does not allow definitive clinical recommendations, and further well-designed trials are needed to clarify the therapeutic role of HA.
Systemic and local antibiotics in the management of peri-implantitis: A systematic review and network meta-analysis.
Shibli JA, Moraschini V, Cotrim KC … +6 more , Barão VAR, Teughels W, Asbi T, Bueno DF, Sculean A, Souza JGS
Periodontol 2000 · 2026 Apr · PMID 41992777 · Publisher ↗
BACKGROUND: Peri-implantitis is a biofilm-induced inflammatory condition with challenging management due to the complexity of implant surface topographies and the polymicrobial and well-structured profile of the biofilm...
BACKGROUND: Peri-implantitis is a biofilm-induced inflammatory condition with challenging management due to the complexity of implant surface topographies and the polymicrobial and well-structured profile of the biofilm colonizing these surfaces. Adjunctive use of antibiotics has been explored to enhance the outcomes of both surgical and non-surgical therapies, but its impact remains questionable. OBJECTIVE: To critically evaluate the clinical effects of systemic and local antibiotic therapies, combined with mechanical debridement (MD), in the surgical and non-surgical treatments for peri-implantitis. MATERIAL AND METHODS: Five databases and gray literature were systematically searched through March 2026. Twenty-one studies involving 1,718 implants were included. Pairwise and network meta-analyses were conducted using random-effects models to compare the efficacy of antibiotic regimens on clinical parameters, including probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BoP), plaque index (PLI), and marginal bone loss (MBL). RESULTS: Systemic metronidazole combined with amoxicillin was most effective in reducing PPD and MBL, especially when used in the surgical treatment of peri-implantitis. For non-surgical intervention, metronidazole demonstrated the most effective results, particularly for CAL and MBL. Minocycline microspheres and the combination of amoxicillin and metronidazole showed the best results among local therapies. Overall, antibiotics improved clinical parameters when compared to mechanical debridement alone, but with substantial microbiological variability depending on the delivery method and intervention type. CONCLUSION: The most effective treatments were metronidazole as adjunct to non-surgical treatment and combined with amoxicillin adjuncts to open flap debridement. While local antibiotic applications also enhance clinical parameters, they appear less effective than systemic regimens. Future well-designed clinical trials focusing on microbiological outcomes and standardized protocols are warranted to optimize periimplantitis management strategies.
The use of pain scales in scientific studies on dentin hypersensitivity: A scoping study.
Gupta C, Barber M, Boissonade F … +3 more , Flannigan N, Wong N, Gibson BJ
Periodontol 2000 · 2026 Apr · PMID 41992718 · Publisher ↗
OBJECTIVE: This scoping review aimed to identify the pain scales used to clinically evaluate dentin hypersensitivity (DH) in existing literature and the references provided for their selection. METHODS: The scoping revie...
OBJECTIVE: This scoping review aimed to identify the pain scales used to clinically evaluate dentin hypersensitivity (DH) in existing literature and the references provided for their selection. METHODS: The scoping review followed the PRISMA and JBI guidelines. An electronic search of the literature was conducted across Web of Science, PubMed (Medline), Scopus, and CINAHL. Eligible studies included adult participants with DH who were assessed using pain scales. After screening, data were extracted and synthesised to identify the most commonly used pain scales and the theoretical and methodological justification for their use. RESULTS: Seventy-one studies were included in the review, and most of them were randomised studies (randomised clinical studies + RCTs = 81.7%). The visual analog scale (VAS) was the most frequently used pain measurement, followed by the Schiff Cold Air Sensitivity scale (SCASS). Use of both scales together was also identified as a common practice. There were inconsistencies in the references provided as the rationale for the use of the pain measurement tools. CONCLUSIONS: VAS and SCASS are unidimensional scales that are used in DH research without an adequate theoretical understanding of the condition and methodological considerations. More research needs to be conducted on the methodological suitability of the pain scales and the conceptual understanding of pain management in DH.
Factors affecting the efficacy of nonsurgical therapy of peri-implantitis.
Calciolari E, Rivara F, Donos N … +2 more , Lasserre JF, Toma S
Periodontol 2000 · 2026 Apr · PMID 41992674 · Publisher ↗
OBJECTIVES AND MATERIALS AND METHODS: This article critically reviews the current knowledge on the factors influencing the efficacy of non-surgical therapy (NST) of peri-implantitis, taking also advantage of the know-how...
OBJECTIVES AND MATERIALS AND METHODS: This article critically reviews the current knowledge on the factors influencing the efficacy of non-surgical therapy (NST) of peri-implantitis, taking also advantage of the know-how from periodontitis management. RESULTS: Despite the limited available literature, it is clear that factors influencing the possibility to access and effectively decontaminate the implant (by the clinician and by the patient) and factors influencing patients' response and their wound healing potential are likely to play a crucial role. In this respect, assessing the appropriateness of implant-supported prostheses and verify their cleanability (and, whenever needed, modify/replace them) becomes of crucial importance. Likewise, promoting smoking cessation, controlling underlying relevant medical conditions (e.g. type 2 diabetes) and improving patient's compliance to meticulous oral hygiene can enhance NST outcomes. CONCLUSIONS: Future studies are needed to better clarify the plethora of factors impacting on NST efficacy and how clinicians can further promote disease resolution by selecting/adapting decontamination protocols, use of adjunctives and motivation strategies. CLINICAL RELEVANCE: Although NST is always the first treatment approach in peri-implantitis management, its efficacy in promoting disease resolution is currently limited, especially in cases presenting advanced pathology and complex peri-implant defect configurations. It is becoming increasingly clear that successful NST does not only entail an effective biofilm removal, but it requires a multi-level approach where the peri-implant tissues are considered in close interrelation with the implant-abutment-prosthesis complex.
Bone biology in aging periodontal and peri-implant tissues.
Issa DR, Intini G, Clark D
Periodontol 2000 · 2026 Apr · PMID 41952645 · Publisher ↗
BACKGROUND: Periodontal disease is an age-related chronic inflammatory condition leading to tooth loss. Dental implants are an option for replacement of lost teeth in older adults. However, age-related changes to alveola...
BACKGROUND: Periodontal disease is an age-related chronic inflammatory condition leading to tooth loss. Dental implants are an option for replacement of lost teeth in older adults. However, age-related changes to alveolar bone may have pathological implications for its role in supporting the dentition and dental implants. AIM: This narrative review will focus on the age-related changes that affect alveolar bone and the implications for periodontal disease and implant dentistry. MATERIALS AND METHODS: A literature search using the PubMed database was conducted. Search terms focused on the known age-related pathological process affecting bone and involved in peri-implant and periodontal disease. CONCLUSION: The literature demonstrates the multi-faceted physiological changes that affect alveolar bone as a function of increased age. Osteoporosis is a commonly recognized feature of aging and studies support its association with periodontal disease as well as the growing body of work demonstrating the effects of osteoporosis on dental implant success. Furthermore, age-related cellular perturbations have a detrimental impact on the strict inflammatory regulation that is required for bone homeostasis and during healing and regenerative processes. Finally, age-related changes to osteoprogenitor cells likely contribute to pathology in the alveolar bone. However, multiple therapeutic targets have been identified to alter osteoprogenitor cell function for improvement of bone regeneration and homeostasis. CLINICAL RELEVANCE: Pathological changes that occur with age can be detrimental to alveolar bone, and an improved understanding of such changes can translate to future treatment modalities for the enhanced management of periodontal disease and dental implants in older adults.
An integrated behavioral change model for smoking cessation in periodontal care: The four-stage behavioral support staircase.
Ramseier CA
Periodontol 2000 · 2026 Apr · PMID 41952635 · Publisher ↗
OBJECTIVES: Smoking tobacco is a critical modifiable risk factor for periodontal and peri-implant diseases. This narrative review integrates established behavioral theories with communication-based psychological processe...
OBJECTIVES: Smoking tobacco is a critical modifiable risk factor for periodontal and peri-implant diseases. This narrative review integrates established behavioral theories with communication-based psychological processes to propose an evidence-based model for smoking cessation support in periodontal care. While the model is developed around smoking cessation, its underlying principles are applicable to broader behavioral risk factor management in dental practice. MATERIALS AND METHODS: Evidence from systematic reviews, randomized controlled trials, and international guidelines was synthesized to determine effective strategies. Key concepts analyzed include the transtheoretical model (TTM), the COM-B model and motivational interviewing (MI), and the impact of personalized risk communication and biofeedback on patient adherence. RESULTS: Structured behavioral interventions, particularly in combination with pharmacotherapy and personalized feedback (e.g., risk scores or biomarker testing), improve quit rates and, consequently, periodontal outcomes. The proposed four-stage behavioral support staircase provides a clinical support structure comprising connection (rapport), information, motivation and action, with continuous evaluation. Complementing this is an "elemental" metaphor to guide clinicians through patient resistance, ambivalence, and the emotional adaptation inherent in cessation. CONCLUSIONS: Smoking cessation serves as a model for how structured behavioral support can be integrated into periodontal therapy. The presented frameworks provide oral health professionals with guidance on the complex cognitive, emotional, and motivational transitions necessary for achieving long-term periodontal stability. CLINICAL RELEVANCE: This educational model enables periodontal teams to systematically address modifiable behavioral risk factors. It offers a four-stage approach to supporting cessation and managing relapse, shifting the focus from didactic instruction to a patient-centered collaborative approach.
Not a miracle, not a myth: The role of probiotics in periodontal health.
Wim T, Mehraveh S, Katalina L … +6 more , Cheah CW, Pisha P, Ana C, Andy T, Naiera Z, Wannes VH
Periodontol 2000 · 2026 Apr · PMID 41952630 · Publisher ↗
BACKGROUND: As the understanding of periodontal disease has evolved, therapeutic strategies have increasingly shifted from pathogen eradication toward ecological modulation of the oral microbiome. Within this paradigm, p...
BACKGROUND: As the understanding of periodontal disease has evolved, therapeutic strategies have increasingly shifted from pathogen eradication toward ecological modulation of the oral microbiome. Within this paradigm, probiotics have emerged as potential adjuncts for maintaining periodontal health by promoting microbial balance and modulating host responses. OBJECTIVE: To summarize the historical development, definitions, and mechanisms of probiotics and to critically evaluate the current clinical evidence supporting their use in periodontal therapy. METHODS: This narrative review examines the conceptual framework of probiotics in oral health, distinguishing them from related approaches including prebiotics, postbiotics, and synbiotics. Literature from randomized controlled trials and meta-analyses was reviewed to assess the clinical effectiveness of probiotic interventions in periodontal therapy and to explore their proposed mechanisms of action. RESULTS: Probiotic effects are highly strain-specific and involve multiple mechanisms, including production of antimicrobial compounds, competition for ecological niches, inhibition of biofilm formation and quorum sensing, strengthening of epithelial barrier integrity, and modulation of host immune and inflammatory responses. Evidence from randomized controlled trials and meta-analyses, particularly those evaluating Limosilactobacillus reuteri strains, suggests that probiotics used as adjuncts to nonsurgical periodontal therapy can significantly improve clinical parameters such as probing pocket depth, clinical attachment level, and bleeding on probing. However, substantial heterogeneity in study design, probiotic strains, delivery systems, and follow-up periods limits the comparability and generalizability of findings. CONCLUSIONS: Probiotics represent a biologically plausible and ecologically oriented adjunct in periodontal therapy. While current evidence indicates beneficial clinical effects, further standardized and long-term clinical trials incorporating advanced microbiome analyses (e.g., next-generation sequencing) are needed to clarify mechanisms, optimize formulations, and support personalized probiotic strategies in periodontal care.
The role of neutrophils in the pathophysiology of inflammatory bowel diseases.
Steffens JP, Yay-Kus E, de Molon RS … +6 more , Stoica V, Rimmer P, Hirschfeld J, Iqbal AJ, Iqbal T, Chapple I
Periodontol 2000 · 2026 Apr · PMID 41952629 · Publisher ↗
OBJECTIVES: Inflammatory bowel disease (IBD) encompasses a spectrum of chronic disorders of the gastrointestinal tract, with a potential bidirectional relationship with periodontitis. Neutrophils are key regulators of im...
OBJECTIVES: Inflammatory bowel disease (IBD) encompasses a spectrum of chronic disorders of the gastrointestinal tract, with a potential bidirectional relationship with periodontitis. Neutrophils are key regulators of immune-inflammatory responses and play a major role in both diseases. Isolating and characterizing gut lumen neutrophils may help to map the evolution of cell phenotypes from peripheral blood to saliva and help explain certain mechanistic relationships within the oral-gut axis. This review aims to critically evaluate the biological sources of human neutrophils and the emerging analytical approaches to their study in IBD. MATERIALS AND METHODS: Studies employing various methodological strategies to isolate and analyze neutrophils derived from both systemic (peripheral blood) and mucosal compartments in IBD are synthesized. Data obtained through different analytical modalities are discussed. RESULTS: Neutrophils play multifaceted roles in IBD beyond their traditional function in pathogen clearance and acute inflammation. They contribute to both tissue injury and repair through the release of proteolytic enzymes, reactive oxygen species, cytokines, and neutrophil extracellular traps. Recent advances in analytical technologies have uncovered remarkable phenotypic and functional diversity, shaped by the local microenvironment within the intestinal mucosa. CONCLUSIONS: Neutrophils' ability to both exacerbate mucosal damage and facilitate resolution of inflammation underscores the need for improved methodological approaches that enable precise characterization of their functional states in both systemic and tissue contexts. CLINICAL RELEVANCE: Improved phenotypic and functional profiling of neutrophils may facilitate the identification of biomarkers predictive of disease activity, treatment response, and relapse risk, and contribute to the understanding of the role of neutrophils in the interplay between IBD and periodontitis.
Long-term periodontal and peri-implant tissue stability under supportive therapy.
Wang HL, Calatrava J, Soldini MC … +3 more , Vilarrasa J, Sculean A, Monje A
Periodontol 2000 · 2026 Apr · PMID 41952577 · Publisher ↗
BACKGROUND: Supportive periodontal and peri-implant maintenance therapy is strongly associated with improved long-term retention and stability of natural teeth and dental implants. Lack of regular professional follow-up...
BACKGROUND: Supportive periodontal and peri-implant maintenance therapy is strongly associated with improved long-term retention and stability of natural teeth and dental implants. Lack of regular professional follow-up after initial therapy is a major risk factor for disease recurrence and tooth or implant loss. Despite well-established benefits, patient compliance with maintenance regimens remains suboptimal, and the ideal protocols and intervals for sustained tissue health are under debate, AIM: This review aimed to synthesize current evidence regarding the impact of supportive therapy on long-term periodontal and peri-implant tissue stability, including optimal maintenance intervals, protocols, risk profiles, and emerging technologies for personalized care. MATERIAL AND METHODS: A comprehensive literature review was conducted using PubMed, Embase, and Scopus databases, focusing on longitudinal and cohort studies, randomized controlled trials, systematic reviews, and recent consensus guidelines addressing the effects of supportive therapy on periodontal and peri-implant outcomes. Data on maintenance intervals, clinical protocols, risk assessment tools, recurrence after nonsurgical and surgical therapies, and adjunctive innovations (AI, imaging, biomarker testing) were collated and critically appraised. RESULTS: Long-term studies consistently demonstrate that regular supportive periodontal care (SPC) and supportive peri-implant care (SPIC) markedly reduce rates of tooth and implant loss, progression of periodontitis and peri-implantitis, and minimize the need for complex surgical re-interventions. Frequent recalls-every 3-6 months for moderate- to high-risk patients and up to 12 months for low-risk-result in significantly better outcomes. Protocols incorporating individualized risk assessment (e.g., Personalized Risk Assessment (PRA) and Implant Disease Risk Assessment (IDRA) algorithms), thorough mechanical biofilm removal, personalized oral hygiene instructions, and modification of risk factors enhance tissue stability. Non-compliance and residual pockets (≥5-6 mm) are major predictors of recurrence. While both conventional and emerging biofilm control methods (ultrasonic scaling, air-polishing, guided biofilm therapy) are effective, no single protocol shows superior long-term results. Recent advances in chair-side biomarker testing and AI-supported image analysis offer promising tools for early detection and proactive management of at-risk patients. Although early data are encouraging, the clinical integration of these technologies remains largely guided by expert interpretation pending long-term outcome validation. CONCLUSIONS: Consistent adherence to structured supportive therapy protocols following active periodontal or implant interventions is essential for the long-term health and stability of periodontal and peri-implant tissues. Maintenance intervals and protocols should be individualized based on patient, site, and prosthetic risk profiles, with cumulative and interceptive strategies employed for disease prevention and early management of recurrence CLINICAL RELEVANCE: The implementation of personalized supportive therapy regimens-including regular recalls, risk-based protocol selection, and integration of emerging technologies-substantially enhances the longevity and stability of teeth and implants. Improving patient and clinician awareness, and adopting risk-stratified approaches, can reduce disease recurrence, treatment burden, and long-term healthcare costs.
Impact and efficacy of systemic antibiotics for peri-implant diseases treatment: A systematic review and meta-analysis on clinical and microbiological outcomes.
Isola G, Polizzi A, Angjelova A … +3 more , Jovanova E, Pizzo G, Sculean A
Periodontol 2000 · 2026 Apr · PMID 41923333 · Publisher ↗
AIM: To evaluate the adjunctive effects of systemic antibiotics (SA) on clinical and microbiological outcomes in the treatment of peri-implant diseases. MATERIALS AND METHODS: A systematic review and meta-analysis were c...
AIM: To evaluate the adjunctive effects of systemic antibiotics (SA) on clinical and microbiological outcomes in the treatment of peri-implant diseases. MATERIALS AND METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines and registered on PROSPERO (CRD420251059056). Randomized and non-randomized clinical trials evaluating SA as adjuncts to non-surgical treatment of peri-implant mucositis (PM) and to non-surgical or surgical therapy of peri-implantitis (PI) were included. Rob2 and MINORS tools were used to assess the risk of bias of included articles. RESULTS: Eighteen studies were included in the qualitative analysis, of which only nine randomized clinical trials met the criteria for quantitative analysis. For PM treatment, SA did not significantly affect any assessed clinical outcomes (p>0.05). For PI treatment, the meta-analysis showed that, in both non-surgical and surgical PI treatment, adjunctive SA resulted in a significant bleeding on probing reduction at 12 months (p=0.007) and a significant probing pocket depth reduction at 12 months (p=0.004). However, no significant improvements in marginal bone level (MBL) were observed. For antimicrobial outcomes, only 2 studies reported significant effects of metronidazole as an adjunct to treatment on reductions in P. gingivalis and T. forsythia up to 12 months. CONCLUSIONS: SA do not provide additional clinical or microbiological benefits in the treatment of PM. In PI, adjunctive systemic antibiotics may offer only limited improvements in selected clinical outcomes and specific peri-implant pathogens for up to 12 months, without consistent benefits on MBL. However, given the heterogeneity of the available evidence, further high-quality, long-term studies are needed.
Accuracy of surrogate outcomes in predicting true endpoints of surgical periodontal therapy. A narrative review with a 20-year longitudinal analysis.
Saleh MHA, Alrmali AE, SamavatiJame F … +5 more , Almanshi H, Alhazmi S, Abu-Reyal S, Wang HL, Decker A
Periodontol 2000 · 2026 Mar · PMID 41881553 · Publisher ↗
BACKGROUND: Periodontal clinical trials commonly use surrogate end points (e.g., probing pocket depth [PPD], clinical attachment level [CAL], bleeding on probing [BoP], and composite scores such as the Periodontal Risk S...
BACKGROUND: Periodontal clinical trials commonly use surrogate end points (e.g., probing pocket depth [PPD], clinical attachment level [CAL], bleeding on probing [BoP], and composite scores such as the Periodontal Risk Score [PRS]) for efficiency, yet tooth loss, treatment burden/cost, and re-treatment are the definitive patient-relevant measures of long-term success. METHODS: This mixed-methods study evaluated the predictive performance of three surrogate definitions and contextualized the findings with a 50-year narrative review of longitudinal evidence linking PPD, CAL, and BoP to tooth retention. Additionally, a retrospective cohort (2001-2024) of 160 patients (919 teeth) treated at the University of Michigan was studied. Each participant had baseline PPD ≥6 mm after initial therapy (sites nonresponsive to initial nonsurgical therapy) and received up to 20 years of supportive periodontal therapy (SPT) following active periodontal therapy (APT). Three surrogate definitions: TEP A (no pockets ≥6 mm), TEP B (pockets ≤4 mm without BoP), and the PRS were compared against two true end points: tooth loss due to periodontitis (TLP) and need for additional therapy (re-treatment). Logistic regression with generalized estimating equations was used to estimate sensitivity, specificity, positive/negative predictive values, and area under the curve (AUC). RESULTS: Overall, tooth loss was 28.4%, with 18.9% due to periodontitis. Additional treatment was required by 91.5% of patients. For TLP, TEP-B provided the highest sensitivity, whereas PRS = 3 provided the highest specificity and positive predictive value (AUC = 0.556, p = 0.021). PRS ≥2 showed the best overall discrimination/accuracy for TLP (AUC = 0.637, p < 0.001). TEP-A and TEP-B demonstrated modest discrimination (AUC = 0.567, p < 0.007 and AUC = 0.549, p = 0.047, respectively). For re-treatment, TEP-B yielded 82.2% sensitivity, and PRS = 3 demonstrated 96.6% specificity (PPV = 96.8%); PRS ≥2 alone achieved AUC = 0.625 (p = 0.033), while no significant differences were observed among the remaining models. CONCLUSIONS: For practical application, baseline risk stratification can be performed using PRS ≥2 to support early screening for periodontitis-related tooth loss, while PRS = 3 can be reserved for high-confidence confirmation when minimizing false positives is critical. During postsurgical follow-up after APT and throughout SPT, TEP-B (PPD ≤4 mm with no BoP) can be used as the primary monitoring target to flag likely instability and identify teeth likely to require re-treatment, whereas PRS = 3 can be applied to guide final treatment decisions or resource-intensive interventions.
Emerging risk factors influencing the occurrence of peri-implantitis.
Monje A, Jung RE, Valles C … +1 more , Naenni N
Periodontol 2000 · 2026 Mar · PMID 41881525 · Publisher ↗
BACKGROUND: The objective of the present review is to explore the evidence and biological plausibility of factors that may expose dental implants to a greater likelihood of developing peri-implantitis. MATERIAL AND METHO...
BACKGROUND: The objective of the present review is to explore the evidence and biological plausibility of factors that may expose dental implants to a greater likelihood of developing peri-implantitis. MATERIAL AND METHODS: An electronic screening on the PubMed library the was carried out to identify potential emerging factors that influence the onset/progression of peri-implantitis. These factors were explored and are presented in a narrative review. RESULTS: Seven major emerging factors were pinpointed as emerging risk factors influencing the onset/progression of peri-implantitis. Concerning (1) anatomy-related risk factors, it seems that crestal soft tissue thickness and the dimension of the mucosal attachment are factors worth being assessed in order to understand the susceptibility of implants to peri-implantitis. In turn, concerning (2) prosthesis-related factors, certain implant-abutment connections may be more prone to peri-implantitis. Moreover, (3) surgery-related factors, in particular as regards inadequate bucco-lingual and mesio-distal positioning, were seen to be contributors to peri-implantitis, while apico-coronal implant positioning might be dictated by the emergence profile and the crestal connective tissue height. Inconclusive findings were obtained concerning (4) the type and materials of implant-supportive restorations. However, a lack of cleansability and the convexity of the emergence profile were suggested to be key elements in promoting inflammation. Implant-supported fixed restorations, in contrast to implant-retained overdentures, may increase the likelihood of developing peri-implantitis in high-risk individuals, since monitoring and plaque control are often jeopardized. Furthermore, (5) the regular intake of certain medication may increase the susceptibility to disease by interrupting regular homeostasis and tissue repair. In turn, (6) non-controlled systemic disorders or a history of peri-implantitis were seen to be strongly associated with peri-implantitis. Lastly, (7) operator-related factors, including the level of training in implant surgery and implant prosthodontics, were also regarded as risk factors for peri-implantitis. CONCLUSIONS: Emerging factors are yet to be validated by scientific data. However, aiming at preventing disease onset and progression, clinicians are encouraged to apply all measures known to affect hard and soft tissue breakdown and plaque accumulation in the pursuit of long-term peri-implant health. Moreover, patient-related factors must be identified for proper patient selection in implant therapy. Education and training in implant surgery and implant prosthodontics are needed to prevent peri-implantitis.
Long-term stability after nonsurgical treatment of periodontitis.
Sánchez IS, Carra MC, de Albornoz AC … +3 more , Romandini M, Montero E, Sanz M
Periodontol 2000 · 2026 Mar · PMID 41881516 · Publisher ↗
BACKGROUND: Non-surgical periodontal therapy (NSPT) remains the fundamental approach in periodontal treatment and has been extensively studied over the past decades. Evidence consistently shows that NSPT exerts a substan...
BACKGROUND: Non-surgical periodontal therapy (NSPT) remains the fundamental approach in periodontal treatment and has been extensively studied over the past decades. Evidence consistently shows that NSPT exerts a substantial and sustained impact on tooth retention and on key surrogate outcomes, including gains in clinical attachment levels, reductions in probing pocket depths and improvements in inflammatory parameters. AIM: To evaluate the long-term (≥5 years) efficacy of non-surgical periodontal therapy and to explore the effect of alternative or adjunctive mechanical methods (e.g., laser, air-polishing devices, etc.) compared to hand, sonic, or ultrasonic instruments in NSPT. MATERIAL AND METHODS: A systematic electronic search was conducted to analyse the scientific literature available by including all potential studies reporting long-term results of the non-surgical periodontal treatment, regardless of study design. To evaluate the effectiveness of alternative protocols for subgingival instrumentation, a systematic electronic sear was also conducted including only randomized clinical trials (RCTs). RESULTS: 27 manuscripts corresponding to 20 investigations reported on the long-term outcomes of non-surgical therapy. Most of the studies showed low incidence of tooth loss, clinical attachment gains at initially deep pockets and probing pocket depth reductions, especially on those patients attending regularly supportive periodontal care (SPC). The use of laser as an alternative to hand instruments or ultrasonic devices, or as adjuncts to subgingival instrumentation has shown conflictive results. Some studies evaluating the adjunctive use of antimicrobial photodynamic therapy have reported modest clinical improvements in the short term (3 to 6 months). Subgingival air-polishing may offer potential benefits for patient comfort and shorter treatment times. CONCLUSIONS: Overall, the available evidence supports NSPT as a reliable and long-lasting treatment option, while emphasizing the need for further research on patient reported outcomes and systemic effects within the long-term framework of comprehensive periodontal treatment. CLINICAL RELEVANCE: Non-surgical periodontal therapy is the key tool for treating periodontitis in most patients. The gold standard treatment is subgingival instrumentation using hand- or power-driven instruments, together with regular SPC. Various alternative or adjunctive therapies have been suggested, but the evidence available is limited, particularly in the long term.
Long-term outcomes of lateral sinus floor elevation: A machine-learning analysis, systematic review, and meta-analysis of predictive factors.
Sabri H, Saleh MHA, Nava P … +3 more , Scaini R, Testori T, Del Fabbro M
Periodontol 2000 · 2026 Mar · PMID 41881515 · Publisher ↗
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 te...
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.
Oral wound healing in the elderly: Mechanisms, challenges, and innovations.
Decker AM, Stuhr SH, Avila-Ortiz G … +5 more , Pilloni A, Marini L, Castilho R, Wallace BI, Hernandez-Kapila YL
Periodontol 2000 · 2026 Mar · PMID 41881503 · Publisher ↗
OBJECTIVE: This narrative synthesizes current knowledge on the biological mechanisms, clinical challenges, and regenerative innovations for optimizing intraoral wound healing in the elderly. METHODS: Narrative review of...
OBJECTIVE: This narrative synthesizes current knowledge on the biological mechanisms, clinical challenges, and regenerative innovations for optimizing intraoral wound healing in the elderly. METHODS: Narrative review of preclinical and clinical studies addressing age-related changes in the four canonical wound-healing phases (hemostasis, inflammation, proliferation, remodeling), tissue-specific molecular pathways, systemic and local factors affecting repair, operative considerations, and emerging therapeutic modalities. Data sources included PubMed, Embase, and Cochrane databases through June 2025. RESULTS: Aging compromises each repair phase. Hemostasis is prolonged by diminished platelet function and altered clot architecture. Inflammation is exacerbated by impaired neutrophil/phagocyte activity and persistent reactive oxygen species. Proliferation is slowed by reduced fibroblast proliferation and angiogenic signaling, while dysregulated matrix metalloproteinase activity impairs extracellular matrix remodeling. Tissue-specific cues in oral mucosa, periodontal ligament, cementum, and bone are also altered with age. Compounding factors-including "inflamm-aging," malnutrition, polypharmacy-induced xerostomia, cognitive decline, and frailty-further impede healing. Clinical optimization requires comprehensive preoperative risk and frailty assessments; medical/nutritional management; minimally invasive flap designs; tension-free primary closure; streamlined surgical protocols to limit operative time; and postoperative monitoring with tailored communication. Emerging regenerative strategies-growth factors (PDGF, FGF), platelet concentrates, gene and cell-based approaches (MSCs, exosomes), immunomodulatory scaffolds/agents, photobiomodulation, and AI-driven risk dashboards-show promise for enhancing repair in aging populations. CONCLUSIONS: Effective oral wound healing in older adults demands a multidisciplinary, personalized approach that integrates meticulous perioperative care with novel regenerative modalities. Standardization and clinical validation of emerging therapies are essential to translate biological insights into improved patient outcomes.
Long-term stability of horizontal bone augmentation at implant sites.
Fu JH, Choo HJS, Ong DS … +1 more , Kwek H
Periodontol 2000 · 2026 Feb · PMID 41664580 · Publisher ↗
Horizontal bone augmentation is a fundamental surgical procedure in regenerative implant dentistry. In recent decades, this procedure has evolved, enabling clinicians to achieve predictable and stable horizontal bone aug...
Horizontal bone augmentation is a fundamental surgical procedure in regenerative implant dentistry. In recent decades, this procedure has evolved, enabling clinicians to achieve predictable and stable horizontal bone augmentation that supports dental implant restorations. This narrative review summarizes the current literature on the biological mechanisms underlying bone regeneration and the key concepts of horizontal bone augmentation using various surgical techniques. A search of the electronic databases PubMed and Medline was conducted to gather scientific evidence regarding the surgical principles, biomaterials, soft tissue considerations, different methods of horizontal bone augmentation, the stability of regenerated bone, and the associated survival rates of implant restorations. The findings indicated that horizontal bone augmentation techniques could reliably increase bone width (ranging from 3 to 5 mm), over follow-up periods of 10 years or more. The long-term stability of this regenerated bone can be predictably attained by considering these four key parameters: (1) Careful case selection: A contained alveolar ridge defect in a non-smoking patient with optimal glycemic control and good oral hygiene. (2) Adherence to biologically sound surgical principles: This includes ensuring primary wound closure, maintaining adequate blood supply, creating and preserving space for augmentation and achieving overall stability of the surgical site during the healing phase. (3) Selection of appropriate biomaterials to facilitate effective bone regeneration. (4) Management of soft tissue through surgical interventions to create a stable wound during bone augmentation, as well as to maintain peri-implant bone health. This review presents clinical cases with long-term follow-up to illustrate the importance of these various aspects of bone augmentation in ensuring predictable long-term stability of regenerated bone.
Zirconia, titanium, and polyetheretherketone implant abutments show equal long-term clinical success-A systematic review and network meta-analysis.
Al-Mohammad YN, Kelly C, Martinekova P … +11 more , Wenning AS, Kiss-Dala S, Gede N, Kerémi B, Németh Z, Hermann P, Czumbel LM, Mikulás K, Hegyi P, Sculean A, Varga G
Periodontol 2000 · 2025 Dec · PMID 41326963 · Publisher ↗
Hundreds of millions of people have one or more missing teeth. Consequently, a substantial number of patients undergo implant therapy each year. However, technical complications and soft tissue inflammation associated wi...
Hundreds of millions of people have one or more missing teeth. Consequently, a substantial number of patients undergo implant therapy each year. However, technical complications and soft tissue inflammation associated with the implant abutment or the type of restoration can lead to bone loss and, ultimately, implant failure. Using the methodology of network meta-analysis to rigorously compare and contrast the clinical performance of the three commonly used abutment materials: titanium (Ti), zirconium (Zr), and polyetheretherketone (PEEK) polymer. Until May 2025, a systematic search was performed in MEDLINE (PubMed), EMBASE, Scopus, and CENTRAL to find clinical studies comparing Ti, Zr, and PEEK implant abutments. Case reports, case series, in vitro, and in vivo studies were excluded. The Risk of Bias Tool 2, ROBINS-I, and GRADE approaches were used for quality and certainty assessment. Thirty-four articles (950 patients) were included, with various follow-ups. All abutments had high survival rates and no significant differences in marginal bone loss (BL), probing depth (PD), bleeding on probing (BOP), and plaque index (PI). There was no significant difference between Zr and Ti for papillary index (PAP), with a general trend toward better results in Zr, which may be of clinical significance. There was a statistically significant difference in soft tissue discoloration (ΔE) values and technical complications of Zr versus Ti [MD: -2.03, CI: -3.89 to -0.18] and [OR: 0.26, CI: 0.09 to 0.72], respectively, indicating better esthetics and fewer technical complications in Zr. Both Ti and Zr are clinically successful and biologically acceptable. PEEK abutments demonstrated comparable characteristics with both Ti and Zr. However, more studies about PEEK and cost-effectiveness analyses should also be performed to find the best options for clinical applications. PEEK can be a good alternative to Ti and Zr abutments for single-tooth replacement in the anterior and premolar regions.
Alveolar bone regeneration after transplantation of immature teeth in orthodontic patients.
Czochrowska E, Plakwicz P
Periodontol 2000 · 2025 Dec · PMID 41324252 · Publisher ↗
The aim of the paper was to present the potential for alveolar bone regeneration following the autotransplantation of immature teeth, based on a literature review and case presentations. Surgical treatment planning for s...
The aim of the paper was to present the potential for alveolar bone regeneration following the autotransplantation of immature teeth, based on a literature review and case presentations. Surgical treatment planning for successful healing is discussed with regard to donor selection, the stage of root development, the morphology and position of the donor tooth and the size of the apical foramen. The follow-up observations include pulp healing, the regeneration of Herwig's epithelial root sheath and periodontal healing. Differences between unerupted and erupted teeth, as well as the role of a dental follicle during the surgical removal of the donor tooth were discussed. Additionally, the changes associated with tooth eruption and the role of the periodontal ligament (PDL) in promoting bone formation after the autotransplantation of immature teeth were described. By utilizing the natural healing capacity of the PDL, autotransplantation represents a valuable treatment option for restoring dentition and promoting alveolar bone regeneration in patients with missing teeth or dental anomalies. Clinical and radiological documentation, along with the treatment descriptions of three young orthodontic patients illustrate the concepts discussed provide clinical guidelines for the autotransplantation of immature teeth.
Late facial growth and continuous dentoalveolar eruption: Implications for optimal dental implant placement.
Valente NA, D'Amato S, Farella M
Periodontol 2000 · 2025 Nov · PMID 41321054 · Publisher ↗
After somatic growth ceases, craniofacial remodeling continues throughout adulthood, and teeth maintain a slow but persistent tendency to erupt. These ongoing skeletal and dental changes contribute to the progressive inf...
After somatic growth ceases, craniofacial remodeling continues throughout adulthood, and teeth maintain a slow but persistent tendency to erupt. These ongoing skeletal and dental changes contribute to the progressive infraocclusion of dental implants. Our aim was to critically evaluate the evidence on late facial growth and continuous dentoalveolar eruption, and their implications for timing, risk assessment, and management of dental implants. A critical review of the current literature was conducted, focusing on longitudinal studies, clinical trials, and systematic reviews addressing residual facial bone remodeling, dentoalveolar eruption, and implant infraocclusion. Particular attention was given to patient-specific factors and patient-reported outcomes. Late craniofacial growth and continuous eruption of natural teeth contribute to spatial discrepancies between implants and adjacent dentition, even in skeletally mature adults. Younger age, increased anterior facial height, hyperdivergent facial patterns, and high smile lines were identified as key risk factors for implant infraocclusion. While delaying implant placement may reduce the risk of infraocclusion, there is no clear age threshold beyond which implants are entirely stable. Certain surgical techniques and prosthetic designs may mitigate long-term infraocclusion, and alternative treatments such as orthodontic space closure or adhesive bridges may provide a viable solution in selected cases. Progressive infraocclusion of implants is a multifactorial phenomenon influenced by residual craniofacial growth and alveolar changes. A thorough understanding of these biological processes and associated risk factors is essential to guide clinicians in selecting the optimal timing for implant placement and in considering alternative treatment strategies when appropriate. An evidence-based, patient-centered approach can help improve long-term functional and aesthetic outcomes, as well as patient satisfaction.
Chemical agents to control biofilm formation in step 1 of care-Toothpastes and mouthwashes/concepts and challenges.
Joosstens M, Valkenburg C, Van der Weijden F
Periodontol 2000 · 2025 Nov · PMID 41277763 · Publisher ↗
Maintaining optimal oral hygiene is important for overall oral care, ensuring the well-being of teeth and their surrounding tissues. In addition, it promotes fresh breath and a pleasing smile. A key element of oral self-...
Maintaining optimal oral hygiene is important for overall oral care, ensuring the well-being of teeth and their surrounding tissues. In addition, it promotes fresh breath and a pleasing smile. A key element of oral self-care is the daily use of toothpaste during regular brushing. This plays an important role in preventing tooth decay and addressing broader oral health concerns like periodontal diseases. Toothpaste ingredients offer significant benefits to oral health, particularly stannous fluoride, which contributes to the efficacy of toothpaste formulations by demonstrating notable anticariogenic and antibacterial properties. However, toothpaste has potential side effects, such as those caused by flavoring, and sodium lauryl sulfate, a foaming agent known for its potential to irritate mucous membranes. Beyond toothpaste, the integration of mouthwash into daily oral care routines offers the potential to further improve overall oral hygiene. Chlorhexidine in mouthwash formulations stands out as an active ingredient that is highly effective. This paper investigates the effects of chemical plaque inhibitors where possible through comprehensive systematic evaluations of existing literature. It aimed to provide an understanding of how chemical agents used in oral self-care contribute to promoting and maintaining optimal oral hygiene.
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