Periodontology 2000[JOURNAL]
Sun
200 papers
Long-term stability of conventional non-regenerative periodontal treatment for furcation defects.
Lin GH, Martinez A, Li V … +4 more , Lee E, Tu KW, Kao R, Wang HL
Periodontol 2000 · 2025 Sep · PMID 40926613 · Publisher ↗
BACKGROUND: Furcation involvement (FI) in multi-rooted teeth poses significant challenges in periodontal therapy due to complex anatomy and difficulty in achieving effective maintenance. FI is associated with increased p...
BACKGROUND: Furcation involvement (FI) in multi-rooted teeth poses significant challenges in periodontal therapy due to complex anatomy and difficulty in achieving effective maintenance. FI is associated with increased periodontal destruction, especially in sites with narrow furcation entrances and deep root concavities. These features hinder effective debridement and compromise the efficacy of periodontal treatments. MATERIALS AND METHODS: This narrative review examines non-regenerative treatment approaches for managing FI, focusing on clinical outcomes and failure rates associated with flap procedures, biologic root reshaping, root amputation, root separation, and root tunneling. RESULTS: Non-regenerative procedures show variable outcomes. Reported failure rates include 20.1% for root amputation (range: 0%-61.1%), 18.8% for root separation (range: 2.9%-38%), and 20.9% for root tunneling (range: 7.1%-42.9%). These variations are influenced by factors such as FI severity, root morphology, and patient hygiene. CONCLUSION: Effective management of FI requires accurate diagnosis, appropriate treatment selection, and individualized maintenance protocols. Long-term success is closely tied to case selection and the patient's commitment to ongoing periodontal maintenance care. CLINICAL RELEVANCE: Understanding the therapeutic prognosis and limitations of non-regenerative approaches in FI cases is essential for optimizing long-term treatment outcomes. Clinicians should emphasize maintenance strategies and consider anatomical challenges when selecting treatment modalities.
Hyaluronic acid: A novel approach in regenerative/reconstructive periodontal therapy?
Pilloni A, Shirakata Y, Marini L … +5 more , Božić D, Miron RJ, Rotundo R, Stavropoulos A, Sculean A
Periodontol 2000 · 2025 Aug · PMID 40820678 · Publisher ↗
BACKGROUND: Although hyaluronic acid (HA) has long been used for many medical applications, only in recent years has it gained greater popularity in the field of periodontics because of its biological effects during woun...
BACKGROUND: Although hyaluronic acid (HA) has long been used for many medical applications, only in recent years has it gained greater popularity in the field of periodontics because of its biological effects during wound healing. Even today, most clinicians are not aware that more than one type of HA exists and that the extent of its biological functions may vary depending upon the particular characteristics of the biomolecule itself. AIM: To review and synthesize the current preclinical and clinical evidence on the biological effects and therapeutic applications of HA in periodontology, with a focus on its role in wound healing and regeneration. MATERIALS AND METHODS: The origin and chemical structure of HA are discussed first, with a focus on the importance of its molecular weight and the possibility of modifying its structure and form. The main biological properties of HA followed by its effects on the cells of periodontal tissues are summarized and followed by the presentation of the results from preclinical studies in animals which have evaluated the effects of HA in various types of defects. Subsequently, the data from clinical studies evaluating the application of HA in nonsurgical periodontal therapy, regenerative periodontal surgery, and mucogingival surgery are summarized, and recommendations for the clinicians are provided. RESULTS: The preclinical and clinical evidence indicates that HA accelerates the wound healing process through inflammatory mechanisms and enhances blood clot stability when applied to the root surface. It also influences the expression of both mineralized tissue markers and cementoblast-specific genes, suggesting a potential role in cementum regeneration. HA strongly promotes osteoprogenitor growth while maintaining stemness, potentially regulating the balance between self-renewal and differentiation during bone regeneration. Additionally, HA enhances periodontal ligament (PDL) cell adhesion and proliferation. It has been shown to improve the proliferative and migratory abilities of cells while inducing the expression of collagen type III alpha 1 (COL3A1) and TGFβ-3 genes, which are characteristic of scarless fetal wound healing. Certain HA formulations upregulate the expression of genes encoding platelet-derived growth factor B (PDGFB), fibroblast growth factor 2 (FGF-2), and epidermal growth factor (EGF), all of which play crucial roles in the healing process. Histologic evidence from animal studies suggests that HA may promote periodontal regeneration when applied both non-surgically and surgically-particularly in intrabony defects, gingival recessions, and, to some extent, in furcation defects. The data from clinical studies revealed that HA leads to statistically significant and clinically relevant improvements of probing depths and clinical attachment levels when used in conjunction with nonsurgical periodontal therapy and surgical therapy in intrabony and recession defects. CONCLUSION: The available data from preclinical and clinical studies provide robust evidence on the effects of HA to enhance periodontal wound healing and regeneration, and on the improved clinical outcomes when HA is used in conjunction with nonsurgical periodontal therapy and regenerative surgery in intrabony and recession defects.
Esthetic and patient-reported outcomes in immediate implants with adjunctive surgical procedures to increase soft tissue thickness/height: A systematic review.
Lambert F, Montero E, Laleman I … +3 more , de Albornoz AC, Yousfi H, Sanz-Sánchez I
Periodontol 2000 · 2025 Aug · PMID 40793935 · Publisher ↗
To explore the impact of soft tissue augmentation procedures during immediate implant placement (IIP) on clinician-assessed esthetic outcomes and patient-reported outcome measures (PROMs). A systematic literature search...
To explore the impact of soft tissue augmentation procedures during immediate implant placement (IIP) on clinician-assessed esthetic outcomes and patient-reported outcome measures (PROMs). A systematic literature search was conducted in PubMed, Cochrane Library, and Embase until March 2024. Two independent reviewers selected randomized and controlled clinical trials with ≥12 months follow-up, evaluating IIP in the premolar-to-premolar area with or without STA. Primary outcomes included esthetic assessments by clinicians (Pink Aesthetic Score, Implant Crown Aesthetic Index and mid-facial soft tissue recession) as well as PROMs. Secondary outcomes comprised post-operative morbidity, soft tissue stability, and interproximal bone changes. Data extraction was done by two independent reviewers, and the risk of bias was assessed using RoB 2.0 or ROBINS-I. Sixteen publications were included. The only relevant finding was that soft tissue augmentation significantly reduced midfacial soft tissue recession (n = 4, WMD = 0.38; 95% CI (0.15, 0.61)). No significant differences could be found between grafting and no grafting regarding the other clinician-assessed esthetic outcomes or for PROMs. Soft tissue augmentation during IIP reduces midfacial soft tissue recession. However, no other effects could be found based on clinician-assessed or patient-reported esthetic outcomes.
The European contribution to osseous resective surgery for the treatment of residual pockets and furcation defects.
Carnevale G, Fonzar A, Graziani F … +1 more , Cairo F
Periodontol 2000 · 2025 Aug · PMID 40757958 · Publisher ↗
For decades, osseous resective surgery along with apically positioned flap procedure has been advocated as a predictable treatment option to reduce residual pockets and minimize periodontal complications during supportiv...
For decades, osseous resective surgery along with apically positioned flap procedure has been advocated as a predictable treatment option to reduce residual pockets and minimize periodontal complications during supportive periodontal care. More recently, Fiber Retention Osseous Resective Surgery (FibReORS) has been suggested to reduce the amount of resected bone during flap surgery. The present review is aimed at assessing the potential advantages of FibReORS in terms of clinical and patient-related outcomes, thus focusing on the role of resective periodontal surgery in a modern clinical scenario.
Long-term surgical treatment outcomes of peri-implantitis.
Monje A, Pons R, Ramanauskaite A … +3 more , Castro A, Schwarz F, Chambrone L
Periodontol 2000 · 2025 Jul · PMID 40693702 · Publisher ↗
BACKGROUND: To assess the long-term results of the surgical treatment of peri-implantitis by means of clinical, radiographic outcomes, and whenever possible, a composite definition of disease resolution. Furthermore, thi...
BACKGROUND: To assess the long-term results of the surgical treatment of peri-implantitis by means of clinical, radiographic outcomes, and whenever possible, a composite definition of disease resolution. Furthermore, this review aimed at evaluating the prognostic indicators of long-term disease recurrence. METHODS: A systematic screening was conducted to identify long-term clinical studies (≥5 years) on the surgical therapy of peri-implantitis. Data pertinent to study methodology, surgical intervention and clinical and radiographic outcomes were retrieved from the original studies. Qualitative assessment was performed. RESULTS: Overall, 17 long-term studies were included in the qualitative synthesis. Due to the heterogeneity, quantitative analysis was not suggested. The mean disease resolution rate was 58.6%. The mean progressive bone loss arrestment (>1 mm) at the latest follow-up following therapy was reached in 69.6%. Resolution of bleeding on probing at the latest follow-up was achieved in 59.9%. The need for retreatment was deemed in 27.2% of the cases. Disease resolution following a second attempt was seldomly evaluated. The implant survival rate resulted in 88.6% (range: 75%-100%). The odds for disease recurrence following surgical treatment of peri-implantitis were ∼8× higher when residual pathogenic pockets were present during follow-up. Moreover, the extent of bone loss, the width (<2 mm) of keratinized mucosa following surgical treatment, and implant surface (modified) influenced disease recurrence. CONCLUSION: The surgical treatment of peri-implantitis yields to favorable outcomes in the long-term. Data suggest that the long-term disease resolution is ∼60% under supportive peri-implant care, while ∼70% exhibit progressive bone loss arrestment. Hence, the need for retreatment is not infrequent. Residual pockets (≥6 mm) following surgical therapy and the advanced extent of bone loss imply a risk for disease recurrence. CLINICAL RELEVANCE: These findings suggest that the surgical treatment of peri-implantitis is effective in the long-term in patients enrolled in supportive peri-implant therapy. However, its predictability can be interfered in scenarios exhibiting advanced lesions or in those that display residual deep pockets following therapy.
Clinician- and patient-reported outcomes following the surgical treatment of single gingival recession defects: A systematic review.
Cairo F, Couso-Queiruga E, Barbato L … +4 more , Rupe C, Stuhr S, Chambrone L, Avila-Ortiz G
Periodontol 2000 · 2025 Jul · PMID 40693671 · Publisher ↗
To analyze the effect of root coverage surgical therapy for the treatment of single gingival recession defects (GRD) in terms of clinician- and patient-reported outcomes (CROs and PROs), with an emphasis on esthetic perc...
To analyze the effect of root coverage surgical therapy for the treatment of single gingival recession defects (GRD) in terms of clinician- and patient-reported outcomes (CROs and PROs), with an emphasis on esthetic perception. The protocol of this PRISMA 2020-compliant systematic review was registered in PROSPERO (CRD517050). Relevant articles reporting the outcomes of randomized controlled trials (RCTs) were identified through a literature search. After final article selection, according to specific eligibility criteria, data were extracted and categorized. Primary outcomes were clinician-reported root coverage esthetic scores (RES) and patient-reported esthetic perception and satisfaction using different assessment methods, such as standardized visual analog scales (VAS). Data were analyzed and the risk of bias in all included studies was assessed. Fifty-eight articles pertaining to 50 different RCTs were selected. A total of 1820 subjects presenting 2219 single GRDs were treated. Key findings derived from the pooled estimates indicated that root coverage and gingival phenotype modification therapy positively influenced both RES and patient-reported esthetic perception and satisfaction values. Compared to the use of a coronally advanced flap (CAF) alone (i.e., monolaminar technique), the use of a CAF in conjunction with a subepithelial connective tissue graft (i.e., bilaminar technique) had a positive impact on both RES and VAS values, whereas CAF in conjunction with soft tissue substitutes only had a beneficial effect on VAS values. Surgical approaches based on lateral flap displacement were associated with superior mean RES values compared to techniques involving coronal flap displacement. Meta-regression analyses revealed a statistically significant positive association between mean root coverage and RES (i.e., the greater the percentage of root coverage, the higher the RES). Conversely, the association between patient-reported esthetic perception and MRC was not statistically significant. In addition, it was observed that dentinal hypersensitivity can be substantially reduced with surgical root coverage therapy, regardless of the treatment modality. Surgical therapy for the correction of single GRDs had a positive effect on both clinician-reported esthetic scores and patient-reported esthetic perception and satisfaction. Bilaminar techniques are generally associated with superior results.
Impact of soft tissue augmentation procedures on esthetics and patient satisfaction in the treatment of peri-implant buccal soft tissue dehiscences: A systematic review and meta-analysis.
Nart J, Valles C, Vilarrasa J … +3 more , Romano F, Baima G, Aimetti M
Periodontol 2000 · 2025 Jul · PMID 40673678 · Publisher ↗
The aim of this systematic review was to assess the performance of soft tissue augmentation (STA) procedures, with or without a modification of the prosthetic rehabilitation, for the treatment of buccal peri-implant soft...
The aim of this systematic review was to assess the performance of soft tissue augmentation (STA) procedures, with or without a modification of the prosthetic rehabilitation, for the treatment of buccal peri-implant soft tissue dehiscence (PSTD) in terms of esthetics and patient-reported outcomes. A systematic review protocol was developed following the PRISMA checklist. Electronic and hand searches were conducted to identify randomized clinical trials (RCTs) and prospective studies on the treatment of buccal PSTD in implants without peri-implantitis, with a follow-up of at least 6 months. Professional assessment of esthetics and self-reported patient satisfaction were considered the primary outcomes, while clinical variables were considered secondary outcomes. Meta-analysis was carried out when possible using a fixed- or random-effect model. Eight publications reporting on five studies (two RCTs and three prospective studies), published from 2013 to 2024 and including a total of 87 patients, were included in this systematic review. All studies evaluated a coronally advanced flap (CAF) with connective tissue graft (CTG) or substitutes, whereas one arm of an RCT employed a tunnel procedure. Two studies included changing of the prosthetic component. Three studies were rated at low risk of bias. A total of 10 meta-analyses were performed. STA using CAF achieved a final professional esthetic score of 7.7 on a 0-10 scale (95% CI: 6.63; 8.83) and showed improvements in terms of patient-reported esthetics on a 0-100 visual analogue scale (60.8; 95% CI: 46.56; 75.01), with moderate-to-high heterogeneity. The estimated reduction in PSTD depth was 2.2 mm (95% CI: 1.76; 2.69), with an estimated rate of complete PSTD coverage of 71% (95% CI: 59; 82). Based on limited evidence, it can be concluded that STA procedures around implants affected by buccal PSTD appear to positively influence both professional and patient-reported esthetics outcomes.
The role of antibiotics in preventing surgical complications in periodontology and implant dentistry.
Chen Z, Chiou LL, Calatrava J … +1 more , Wang HL
Periodontol 2000 · 2025 Jul · PMID 40665923 · Publisher ↗
Antibiotics are commonly prescribed in periodontal and implant surgeries, either before, during or after surgery, to prevent postoperative infection and reduce early implant failure. However, the potential benefits may b...
Antibiotics are commonly prescribed in periodontal and implant surgeries, either before, during or after surgery, to prevent postoperative infection and reduce early implant failure. However, the potential benefits may be undermined by the risks of resistance and sensitization, thus requiring a strict indication for prescription. There are controversial views regarding the indication, dosage, duration, and timing of antibiotic medication in periodontal and implant surgery. Therefore, the aim of this review is to address the benefits and concerns regarding the efficacy of using preventive antibiotic therapy in Periodontology and Implant Dentistry. Specifically, various types of procedures were comprehensively explored, and recommendations were given accordingly. The available evidence indicates that preventive antibiotic therapy is not warranted for periodontal surgeries, including conventional, plastic, and regenerative procedures. While antibiotic prophylaxis has shown effectiveness in preventing early implant failures in straightforward implant placements, postoperative coverage does not appear to be justified. Furthermore, antibiotic administration has not proven to significantly reduce early implant failure rates in implant placements involving simultaneous guided bone regeneration. There remains insufficient evidence to support or oppose the use of preventive antibiotic therapy for reducing infection rates after ridge or sinus augmentation procedures, nor is there evidence favoring any specific protocol over others.
Three-dimensional digital quantitative analysis of periodontal and peri-implant phenotype-A narrative review.
Te Lin Y, Li C, Korostoff J … +3 more , Fiorellini JP, Yang J, Chang YC
Periodontol 2000 · 2025 Jul · PMID 40641458 · Publisher ↗
3D digital evaluation of the periodontal and peri-implant tissue, including CBCT, intraoral scanning, optical surface scanning, and ultrasonography, is being used in the clinical arena with increasing frequency. Thus, to...
3D digital evaluation of the periodontal and peri-implant tissue, including CBCT, intraoral scanning, optical surface scanning, and ultrasonography, is being used in the clinical arena with increasing frequency. Thus, to validate the utilization of 3D digital analysis for this purpose, a critical evaluation of the reliability of digital approaches relative to conventional methodologies is necessary. Therefore, the goal of the present review is to provide a summary of the existing literature addressing the use of CBCT and intraoral scanning to evaluate the periodontal and peri-implant tissues, highlighting both the advantages and disadvantages of 3D digital methodologies versus conventional approaches. A synopsis of currently available hardware and software is provided. Finally, the review discusses the implications of artificial intelligence in the future development of digital technology for assessing the structures of the periodontal and peri-implant tissue. This review provides a foundation for understanding current 3D digital analysis approaches for the evaluation of periodontal and peri-implant phenotype. While current CBCT and intraoral scanning technologies provide accurate quantitative measurements comparable to conventional methods, the full potential of 3D digital clinical data has not been undermined. Future advancement requires a fundamental shift in how we conceptualize and analyze periodontal and peri-implant tissue relationships in three-dimensional space, moving beyond conventional evaluation protocols. Integration of artificial intelligence and deep learning tools with these comprehensive 3D datasets in the future will enable more precise diagnosis and treatment outcome assessment, revolutionizing how we evaluate periodontal and peri-implant phenotypes.
Engineered surface strategies to manage dental implant-related infections.
Souza JGS, Nagay BE, Martins R … +5 more , Bertolini M, Shibli JA, Aparicio C, Feres M, Barão VAR
Periodontol 2000 · 2025 Jul · PMID 40626507 · Publisher ↗
When exposed to the oral environment, dental implants, like natural surfaces, become substrates for microbial adhesion and accumulation, often leading to implant-related infections-one of the main causes of implant failu...
When exposed to the oral environment, dental implants, like natural surfaces, become substrates for microbial adhesion and accumulation, often leading to implant-related infections-one of the main causes of implant failure. These failures impose significant costs on patients, clinicians, and healthcare systems. Despite extensive research, there is no consensus on the most effective protocol for managing peri-implantitis. Biomedical engineering has aimed to address this challenge by developing biocompatible implants with surface properties designed to enhance biological responses and reduce polymicrobial accumulation. Due to the complexity of interactions between implants and biological systems, no single material property can drive these processes. Instead, a combination of physical, chemical, and mechanical properties is required to ensure a safe and effective response. Antimicrobial coatings are developed either by incorporating antimicrobial agents onto surfaces or modifying the material's physicochemical properties. These coatings utilize a range of compounds for contact-killing or as drug-delivery systems. While biomaterials science has advanced rapidly in enhancing implant surfaces, these bioengineering techniques have progressed more rapidly than our understanding of the pathogenesis of implant infections. To bridge this gap, biomedical engineering must address emerging knowledge about implant infections, focusing on controlling microbial accumulation while simultaneously managing inflammatory responses to support tissue healing. This review critically evaluates current evidence on implant infection pathogenesis, antimicrobial coating technologies, and systematically assesses their in vivo (animal and human evidence) efficacy to guide future advancements in implant infection mitigation.
Long-term outcomes of post-extraction alveolar ridge preservation and alveolar ridge reconstruction followed by delayed implant placement: A systematic review.
Avila-Ortiz G, Couso-Queiruga E, Stuhr S … +1 more , Chambrone L
Periodontol 2000 · 2025 Jul · PMID 40605823 · Publisher ↗
This systematic review analyzed the long-term outcomes of alveolar ridge preservation (ARP) and alveolar ridge reconstruction (ARR) before delayed implant placement. Eight studies were included (one non-randomized clinic...
This systematic review analyzed the long-term outcomes of alveolar ridge preservation (ARP) and alveolar ridge reconstruction (ARR) before delayed implant placement. Eight studies were included (one non-randomized clinical trial, one prospective case series, four retrospective comparative studies, and two retrospective case series). Risk of bias assessment, using a modified Newcastle-Ottawa Scale, revealed one high-quality study, four medium-quality studies, and three with low methodological quality. In total, 333 patients underwent ARP or ARR, with the most common approach involving xenogeneic bone grafting and socket sealing with a collagen membrane, matrix, or dressing. Follow-up ranged from 5 to 10 years. Due to methodological heterogeneity and limited data, quantitative analysis was not feasible. The implant survival rate was the most frequently reported outcome, followed by peri-implant marginal bone level changes and peri-implant disease incidence. Despite limited evidence, ARP and ARR appear to support favorable long-term outcomes, particularly in implant survival and bone stability. Further well-designed, large-scale studies comparing different ARP and ARR modalities with other therapies are needed to guide clinical decision-making.
Orthodontic treatment in periodontitis patients.
Chackartchi T, Polak D, Stabholz A … +1 more , Chaushu S
Periodontol 2000 · 2025 Jun · PMID 40569018 · Publisher ↗
This paper examines the complex interplay between orthodontic intervention and periodontal conditions in individuals with periodontitis. It outlines diagnostic and treatment approaches for adolescents and adults, conside...
This paper examines the complex interplay between orthodontic intervention and periodontal conditions in individuals with periodontitis. It outlines diagnostic and treatment approaches for adolescents and adults, considering their distinct periodontal, dental, and behavioral needs. Furthermore, the paper highlights the detrimental effects of orthodontic tooth movement in the presence of periodontal disease, emphasizing the critical importance of maintaining periodontal health throughout treatment. A comprehensive treatment strategy is presented, including the treatment sequence and periodontal maintenance during orthodontic tooth movement.
Emerging locally delivered antimicrobial and immunomodulatory approaches for the prevention/treatment of peri-implant diseases.
Monje A, Amerio E, Mallor I … +1 more , Aparicio C
Periodontol 2000 · 2025 Jun · PMID 40553005 · Publisher ↗
Peri-implant diseases are dysbiosis-mediated inflammatory disorders that occur in susceptible hosts. Antimicrobials and immunomodulatory agents therefore might be pertinent as adjunctive measures in the treatment of such...
Peri-implant diseases are dysbiosis-mediated inflammatory disorders that occur in susceptible hosts. Antimicrobials and immunomodulatory agents therefore might be pertinent as adjunctive measures in the treatment of such disorders. The aim of this narrative review was to examine the existing evidence and assess the effectiveness of emerging locally delivered antimicrobial and immunomodulatory approaches for the prevention/treatment of peri-implant diseases. An electronic search in the PubMed library was carried out to identify traditional and emerging locally delivered antimicrobial and immunomodulatory approaches for the prevention/treatment of peri-implant diseases. A narrative review was conducted to shed light on the role of these approaches to prevent and treat peri-implant diseases. The use of traditional locally delivered antimicrobials as an adjunct to the nonsurgical or surgical treatment of peri-implant diseases has been shown to be safe and effective to a certain extent. Nevertheless, the body of evidence is limited, which precludes the drawing of firm conclusions/recommendations on their daily use for the treatment of these disorders. Likewise, the existing evidence on traditional immunomodulatory approaches is scarce, and so firm conclusions/recommendations on their daily use for the treatment of these disorders cannot be made. Among the emerging antimicrobials and immunomodulatory strategies, argon plasma and lasers seem to offer benefits for the prevention and treatment of peri-implant diseases, respectively. Significant advances have been made in the understanding and potential of novel locally delivered and immunomodulatory approaches for the prevention/treatment of peri-implant diseases. Nevertheless, their clinical application is still limited by a lack of control over the bioactivity afforded by the known delivery systems and the scarcity of consistent nonclinical and clinical data. Awareness must be raised on the part of the industry to develop feasible agents/tools to enhance the efficacy of preventive and therapeutic strategies.
The relationship between maternal periodontitis and congenital cytomegalovirus: A hypothetical model and therapeutic implications.
Slots J
Periodontol 2000 · 2025 Jun · PMID 40539453 · Full text
BACKGROUND: The primary goal of periodontology is to prevent tooth loss and reduce the risk of focal infections. Periodontitis lesions can harbor hundreds of thousands of active cytomegaloviruses (virions), which can eas...
BACKGROUND: The primary goal of periodontology is to prevent tooth loss and reduce the risk of focal infections. Periodontitis lesions can harbor hundreds of thousands of active cytomegaloviruses (virions), which can easily enter the systemic circulation and potentially infect the fetus of a mother with compromised immunity. The healthy, non-inflamed periodontium contains no PCR-detectable cytomegalovirus. Maternal cytomegalovirus may be linked to cleft lip and cleft palate, prepubertal and juvenile periodontitis, and systemic diseases. AIM: This article presents an anti-cytomegalovirus periodontal therapy aimed at preventing congenital cytomegalovirus disorders. MATERIALS AND METHODS: Immunodeficient and periodontitis-affected women in the pre-gestational period or the first trimester of pregnancy are prime candidates for periodontal treatment. The periodontal diagnosis and drug treatment ought to be performed by well-informed dentists (periodontists). Treatment consists of a one-time valacyclovir regimen (1 g BID on days 1 and 2, and 500 mg BID on days 3-7), subgingival and supragingival ultrasonic scaling using a 0.1%-0.2% sodium hypochlorite cooling solution, individually tailored oral hygiene instructions, and patient-administered daily subgingival irrigation with a 0.1%-0.2% sodium hypochlorite solution. RESULTS: Cytomegalovirus in maternal periodontitis likely serves as a critical nidus for fetal infection. The combined treatment of valacyclovir, ultrasonic scaling, and sodium hypochlorite rinses markedly reduces or eliminates the mother's periodontal cytomegaloviruses. CLINICAL RELEVANCE: The proposed noninvasive anti-cytomegalovirus periodontal therapy is highly safe for the pregnant mother and the fetus. The anti-cytomegalovirus periodontal treatment is expected to control the mother's periodontal cytomegalovirus load and, consequently, part of the baby's congenital disease risk. Research is encouraged on the relationship between periodontal cytomegalovirus and congenital diseases.
The role of the oral microbiome, host response, and periodontal disease treatment in Alzheimer's disease: A primer.
Chalmers JC, Hernandez-Kapila YL
Periodontol 2000 · 2025 Jun · PMID 40495582 · Full text
BACKGROUND: Alzheimer's disease (AD) is the leading cause of cognitive impairment and dementia in elderly patients worldwide. There is increasing evidence that periodontal disease may have an important role in the comple...
BACKGROUND: Alzheimer's disease (AD) is the leading cause of cognitive impairment and dementia in elderly patients worldwide. There is increasing evidence that periodontal disease may have an important role in the complex, multifactorial pathogenesis of AD. AIM: This narrative review aims to (1) highlight the current understanding of the role of periodontal disease in AD, including molecular and immunological evidence, epidemiological studies, and biological mechanisms linking periodontal disease to AD; and (2) explore the potential impact of periodontal therapy as part of an individualized, multitherapeutic approach to AD. MATERIALS AND METHODS: A literature search of the PubMed database was conducted using Boolean search strategies to identify publications related to the potential connections between periodontal disease and AD. RESULTS: Most of the evidence for a link between periodontal disease and AD is limited to preclinical research and epidemiological investigations. A direct causal link has not yet been demonstrated in human clinical studies, but periodontal pathogenic bacteria have been detected in brain tissue and cerebrospinal fluid of patients with AD. Further, colocalization of gingipain proteases secreted by Porphyromonas gingivalis has been found in AD pathological lesions. Epidemiological studies support associations between periodontal disease and increased risk/prevalence of cognitive decline, AD, and AD mortality. Two mechanistic theories have been proposed to explain the connection between periodontitis and AD: the "microbial involvement" theory focuses on periodontal disease-associated pathogenic bacteria, whereas the "inflammatory cascade" theory focuses on proinflammatory mediators as drivers of neuroinflammation that may exacerbate pathologic lesions associated with AD. Preclinical studies of periodontal therapies targeting oral microbiota or their byproducts have investigated small-molecule gingipain inhibitors and novel therapeutics that restore oral microbial homeostasis (e.g., probiotic bacteriocin nisin). In animal models, gingipain inhibitors and nisin showed inhibitory effects on formation of pathological lesions of AD or neuroinflammation and microbiome changes, respectively; however, no impact on cognition was found with use of gingipain inhibitors in patients with mild-to-moderate AD. CONCLUSIONS: Additional studies are needed to better understand the potential causal relationship between periodontal disease and AD, including further exploration of therapies targeting the oral-brain axis.
Scoring algorithm for predicting periodontitis in dentate adults using self-report measures - National Health and Nutrition Examination Survey 2009-2012.
Eke PI, Wei L, Thornton-Evans G … +1 more , Borgnakke WS
Periodontol 2000 · 2025 Jun · PMID 40492463 · Publisher ↗
AIM: Our goal was to develop and externally validate oral health self-report measures for predicting periodontitis in a representative U.S. adult population (30-79 years old) and to evaluate a predictive scoring tool for...
AIM: Our goal was to develop and externally validate oral health self-report measures for predicting periodontitis in a representative U.S. adult population (30-79 years old) and to evaluate a predictive scoring tool for periodontitis constructed from the best performing model parameter estimates. METHODS: The predictive models for periodontitis using demographic characteristics and self-reported oral health measures were developed and tested with the National Health and Nutrition Examination Survey (NHANES) 2009-2012 data (development 2009-2010, validation 2011-2012). The best performing model was externally validated against clinical periodontitis cases defined by measurements from a full-mouth periodontal examination at six sites around all teeth excluding third molars. A predictive scoring tool derived from the transformed sum of the model coefficient estimates was also externally validated. Model performances were evaluated by their sensitivity, specificity, predictive accuracy, and area under the receiver-operating characteristic curve (AUROC). RESULTS: Our best model used self-reported oral health, smoking, and demographics. Predictive Risk Scores (PRS) of ≥65 captured about 98% of the true periodontitis cases. Three forms of the model (1-individual risk factor variables, 2-continuous PRS, and 3-PRS categories) were applied to the development and validation data sets. Overall, all three forms had high sensitivity (>84%) in both the development and validation data sets and had similar AUROC (around 80%). Specificity was low to moderate. When externally validated, the model incorporating PRS as a continuous measure had high sensitivity (84.0%) and low specificity (57.5%), with AUROC of 79.5% and predictive accuracy of 71.6%. Similarly, when PRS as a categorical variable was externally validated, the model had a high sensitivity (82.8%) and low specificity (59.9%), with an AUROC of 79.3% and predictive accuracy of 72.0%. CONCLUSION: Overall, modeling of four self-report oral health measures, combined with smoking and demographic characteristics, performs well in predicting clinical periodontitis in a nationally representative sample of the adult dentate US adult population. Compared with clinical periodontal examination, this approach is promising as a viable, non-clinical, and much less resource-intensive alternative method for estimating the burden of periodontitis.
30 years of enamel matrix derivative: Mimicking tooth development as a clinical concept.
Miron RJ, Shirakata Y, Ahmad P … +5 more , Romandini M, Estrin NE, Farshidfar N, Bosshardt DD, Sculean A
Periodontol 2000 · 2025 Jun · PMID 40457946 · Publisher ↗
The use of growth factors (GFs) has become a cornerstone of modern regenerative periodontology. While the extent to which GFs enhance tissue regeneration compared to other biomaterials was initially uncertain, it is now...
The use of growth factors (GFs) has become a cornerstone of modern regenerative periodontology. While the extent to which GFs enhance tissue regeneration compared to other biomaterials was initially uncertain, it is now well established that GFs play a critical role in the regeneration of various tissue types. In the context of periodontal regeneration, enamel matrix derivative (EMD/Emdogain) has been a key biomaterial for over 30 years. Pioneering work by Lars Hammarström in the mid-1990s led to a wealth of publications on the clinical concept of mimicking tooth development to promote periodontal regeneration. This approach has been shown to induce the formation of new cementum, with functionally oriented periodontal ligament fibers and new alveolar bone. This review begins with an overview of the biological basis of EMD, highlighting its role as a protein (primarily amelogenins) and growth factor complex that initiates and mimics tooth development. Subsequently, histological evidence from animal and human studies using EMD is presented, alongside a discussion of ongoing research avenues. Clinical outcomes are then narratively reviewed, focusing on EMD safety, early wound healing properties, and applications in various scenarios, including non-surgical periodontal therapy, intra-bony and furcation defects, periodontal regeneration, and as an adjunct to soft-tissue grafting. The use of EMD has gained tremendous evidence over the past 30 years as a GF capable of enhancing both hard and soft tissue regeneration in periodontal therapy.
Mystery and misery of locally-delivered drug therapy in periodontics. Historical concepts and current state.
Mombelli A, Zekeridou A
Periodontol 2000 · 2025 May · PMID 40439337 · Publisher ↗
The primary objective is to critically analyze approaches to local therapy for periodontal disease, particularly in light of its well-established systemic implications. We specifically address common misconceptions and o...
The primary objective is to critically analyze approaches to local therapy for periodontal disease, particularly in light of its well-established systemic implications. We specifically address common misconceptions and overestimations regarding the potential of local treatments in contrast to their actual clinical effectiveness. Historically, the therapeutic approach to periodontitis has concentrated on local intervention within periodontal pockets. Local drug delivery systems show potential for targeting periodontal infections with high drug concentrations while minimizing systemic side effects. This could potentially help overcome the challenges posed by microbial biofilms. However, evidence suggests that periodontitis is not a disease affecting only confined areas of a dentition. Currently, in the presence of multiple deep pockets, local therapy is less cost-effective than systemic antibiotics due to the costs of products and the extensive professional chair time required for their application. Isolated deep pockets in otherwise stable dentitions are often caused by problems that cannot be resolved with antimicrobial agents. Finally, recurrent biofilm formation in residual pockets during the maintenance phase can be addressed through suitable physical rather than chemical procedures.
Supportive periodontal care during active orthodontic therapy in patients with history of stage IV periodontitis: A narrative review.
Stähli A, Orishko A, Imber JC … +4 more , Roccuzzo A, Sculean A, Kloukos D, Salvi GE
Periodontol 2000 · 2025 Apr · PMID 40256787 · Publisher ↗
The present narrative review aims to summarize the existing literature on recommendations for supportive periodontal care (SPC) in patients undergoing combined periodontal-orthodontic treatment. It outlines a comprehensi...
The present narrative review aims to summarize the existing literature on recommendations for supportive periodontal care (SPC) in patients undergoing combined periodontal-orthodontic treatment. It outlines a comprehensive step-4 treatment sequence in patients diagnosed with stage IV periodontitis and concurrent orthodontic problems. The delivery of SPC characterizes step 4 of the comprehensive treatment sequence, focusing on the prevention of bacterial re-infection and the recurrence of the disease. Step 4 includes repeated assessments of residual probing pocket depths (PPD) greater than 5 mm, bleeding on probing (BoP) and/or suppuration around teeth and implants, as well as evaluation of furcation involvement. Extensive evidence indicates the efficacy of rigorous self-performed plaque control and adherence to regular SPC following active periodontal therapy as vital for managing caries and periodontitis, thereby reducing possible tooth loss. Current evidence indicates that patients with stage IV periodontal disease can safely proceed with orthodontic treatment following active periodontal therapy. Nonetheless, it is the authors' recommendation for patients undergoing periodontal-orthodontic treatment to participate in an SPC program scheduled every 3-4 months.
Soft-tissue volume augmentation during early, delayed, and late dental implant therapy: A systematic review and meta-analysis on professionally determined esthetics and self-reported patient satisfaction on esthetics.
Ramanauskaite A, Sadilina S, Schwarz F … +3 more , Cafferata EA, Strauss FJ, Thoma DS
Periodontol 2000 · 2025 Apr · PMID 40241249 · Publisher ↗
The objective of the study was to assess the effect of soft-tissue volume augmentation during early, delayed, and late dental implant therapy in terms of professionally determined esthetics and self-reported patient sati...
The objective of the study was to assess the effect of soft-tissue volume augmentation during early, delayed, and late dental implant therapy in terms of professionally determined esthetics and self-reported patient satisfaction on esthetics. For this, a comprehensive electronic literature search was performed to identify randomized clinical trials (RCTs) and controlled clinical trials (CCTs) reporting professionally determined esthetic outcomes and self-reported patient satisfaction on esthetics (primary outcomes) during early, delayed, and late dental implant placement comparing soft-tissue volume augmentation to the absence of soft-tissue grafting (control) (PICO 1) or comparing various soft-tissue augmentation techniques, procedures, and materials (PICO 2). Secondary outcomes were mucosal thickness (MT), intra- and postoperative complications, marginal soft-tissue-level changes, keratinized tissue width, radiographic marginal bone levels, and clinical parameters for the diagnosis of peri-implant tissue health. The standard mean differences (SMD)/weighted mean differences (WMD) were estimated for the Pink Esthetic Score (PES), self-reported patient satisfaction assessed by Visual Analog Scale (VAS) and MT gain for PICO 1 and PICO 2 by employing a random effect model. Five RCTs were included for PICO 1, whereas 7 RCTs and 1 CCT addressed PICO 2. PICO 1: The SMD for the PES between autogenous soft-tissue grafting (SCTG) and the absence of grafting (control group) was 0.47; 95% CI [-0.15, 1.09; p = 0.14] based on 5 RCTs. The SMD for the VAS values for patient-reported satisfaction on esthetics in the SCTG and control group was 0.46; 95% CI [-0.12, 1.03; p = 0.12] (2 RCTs). The WMD for gain of MT amounted to 1.06 mm; 95% CI [0.81, 1.31; p = 0.00] in favor of the SCTG group (3 RCTs). PICO 2: The SMD for the PES comparing collagen-based matrices (CM group) to the SCTG group was -0.32; 95% CI: (-0.57, -0.07; p = 0.01), in favor of the SCTG group (5 RCTs and 1 CCT). The SMD for the VAS for patient-reported satisfaction on soft-tissue esthetics was 0.24; 95% CI: (-0.31, 0.78; p = 0.40) (2 RCTs comparing CM vs. SCTG). The WMD for gain of MT was -0.27 mm; 95% CI: (-0.36, -0.17; p = 0.00), significantly favoring the SCTG group (4 RCTs). Professionally and patient-assessed outcomes showed no substantial differences between autogenous soft-tissue grafting and the absence of grafting for early, delayed, and late implant placement. However, autogenous soft-tissue grafts led to significantly improved esthetic outcomes as assessed by professionals compared to soft-tissue substitutes. Patient-assessed outcomes, nevertheless, were similar regardless of the grafting material (i.e., SCTG or soft-tissue substitute). Therefore, autogenous soft-tissue grafting, though, resulted in a considerably higher gain in mucosal thickness compared to both the absence of soft-tissue grafting and the use of soft-tissue substitutes. Complications and adverse events were rarely reported by the included studies, thus suggesting that many trials underreport harms (e.g., complications).
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