Periodontology 2000[JOURNAL]
Sun
200 papers
Patient-centered perspectives and feelings on peri-implantitis and its therapy.
Lee J, Ko YC, Lee SJ … +2 more , Schwarz F, Koo KT
Periodontol 2000 · 2026 Jul · PMID 42394312 · Publisher ↗
OBJECTIVES: Peri-implantitis is a common biological complication of dental implant therapy that affects peri-implant tissues as well as patients' psychological well-being and oral health-related quality of life. This rev...
OBJECTIVES: Peri-implantitis is a common biological complication of dental implant therapy that affects peri-implant tissues as well as patients' psychological well-being and oral health-related quality of life. This review summarizes patient-centered perspectives on peri-implantitis, focusing on patient perception at diagnosis, treatment experiences, and treatment-related discomfort. MATERIALS AND METHODS: A narrative review of the literature was conducted to identify studies addressing patient perceptions, emotional responses, and patient-reported outcomes related to peri-implantitis management. Evidence from qualitative studies, cross-sectional investigations, and clinical trials reporting patient-centered outcomes was evaluated. RESULTS: The literature shows that peri-implantitis often progresses with minimal or no subjective symptoms, resulting in a discrepancy between clinical findings and patient awareness at diagnosis. Disclosure of the diagnosis is frequently associated with anxiety, stress, and concerns regarding implant prognosis and treatment burden. During treatment, patients commonly anticipate considerable pain and invasiveness; however, actual treatment-related discomfort is generally mild to moderate and transient, with postoperative pain peaking early and resolving within a short period. Patient experiences are strongly influenced by the clarity of diagnostic explanations, expectation management, and the quality of clinician-patient communication. CONCLUSIONS: Peri-implantitis has a measurable psychosocial impact beyond clinical parameters. Patient perceptions at diagnosis and during treatment play a key role in treatment acceptance and adherence. CLINICAL RELEVANCE: Many patients are diagnosed with peri-implantitis without prior awareness of the disease. Clear communication regarding diagnosis, expected treatment-related discomfort, and prognosis may reduce anxiety, improve treatment acceptance, and support long-term maintenance care.
Of mice and men-The emerging oral-gut-brain axis of health and disease.
Hernandez-Kapila YL, Weisenberger DJ
Periodontol 2000 · 2026 Jul · PMID 42394275 · Publisher ↗
OBJECTIVES: Oral health's inextricable links to systemic health are highlighted by the emerging oral-gut-brain axis and other well-known axes. There is growing evidence of a complex oral-gut-brain axis linking mouth and...
OBJECTIVES: Oral health's inextricable links to systemic health are highlighted by the emerging oral-gut-brain axis and other well-known axes. There is growing evidence of a complex oral-gut-brain axis linking mouth and gut microbiomes with the central nervous system. Axis disruptions, characterized as oral and gut dysbiosis or microbial imbalances, can trigger oral and systemic inflammation and neuroinflammation, contributing to diseases such as Alzheimer's disease and Parkinson's disease. MATERIALS AND METHODS: We summarize the oral-gut-brain axis mechanistic pathways, key evidence from human clinical and animal studies, and how the oral microbiome modulates human health and disease. RESULTS: Periodontal disease (PD) is associated with increased oral pathogen presence in diseased tissues throughout the human body. Preclinical models recapitulate these findings. Experimental periodontal infection induces dysbiosis that is linked to activation of inflammatory pathways that promote diseased phenotypes. Novel therapeutic approaches, including the probiotic fbacteriocin nisin, are increasingly recognized for targeted microbiome therapy at multiple inflection points across the axis. Nisin restores microbial balance, reduces inflammation, inhibits end-organ pathology, prevents periodontal bone loss, and reduces brain amyloid/tau accumulation and cytokine expression. CONCLUSIONS: These findings highlight the complexity of the oral-gut-brain axis and the ability to modulate the axis using bacteriocin-based approaches. CLINICAL RELEVANCE: Future probiotic or antimicrobial strategies aimed at ameliorating neuroinflammatory and metabolic diseases via microbiome-targeted therapy hold clinical promise.
Effects of non-surgical periodontal therapy on intrabony periodontal defects at different re-evaluation time points: A systematic review of randomized controlled trials and clinical recommendations.
Ramaglia L, Iorio-Siciliano V, Mauriello L … +2 more , Blasi A, Sculean A
Periodontol 2000 · 2026 Jun · PMID 42363664 · Publisher ↗
OBJECTIVE: The aim of this systematic review and meta-analysis was to evaluate the longitudinal temporal pattern of periodontal probing depth (PPD) reduction in intrabony periodontal defects following non-surgical period...
OBJECTIVE: The aim of this systematic review and meta-analysis was to evaluate the longitudinal temporal pattern of periodontal probing depth (PPD) reduction in intrabony periodontal defects following non-surgical periodontal therapy (NSPT), both as a monotherapy and with adjunctive locally delivered pharmacological agents. MATERIALS AND METHODS: A comprehensive electronic search was performed in PubMed/MEDLINE and Embase databases to identify randomized controlled trials (RCTs). Eligible studies included adult patients with vertical defects treated with NSPT and reporting defect-level PPD values at predefined follow-up intervals (3, 6, 9, or 12 months). Pairwise temporal comparisons were conducted within treatment arms (6 vs. 3, 9 vs. 6, and 12 vs. 6 months) using standardized mean differences (SMD) in a random-effects model. Risk of bias was assessed with the Cochrane RoB 2 tool and certainty of evidence with GRADE. RESULTS: Eight RCTs met the inclusion criteria. Significant PPD reduction occurred between 3 and 6 months (SMD = -1.07; 95% CI -1.70 to -0.45, p < 0.001). Further significant improvements were detected between 6 and 9 months (SMD = -1.35; 95% CI -2.08 to -0.63) and sustained at 12 months compared to 6 months (SMD = -1.70; 95% CI -2.73 to -0.66). High heterogeneity was observed (I = 83-89%). Temporal PPD reduction across consecutive follow-up intervals was considered the primary outcome. Subgroup analyses suggested similar trends for both NSPT alone and adjunctive therapies. CONCLUSIONS: Clinical healing of intrabony defects after NSPT is a dynamic process extending up to 12 months, far beyond the traditional 3-months mark. Initial re-evaluation at 3 months primarily assesses inflammation control, whereas a 6-12 months window more accurately reflects definitive outcomes. CLINICAL RELEVANCE: Clinicians should exercise caution when scheduling surgical intervention for vertical defects. Delaying definitive decisions beyond 3 months for sites showing progressive improvement may avoid unnecessary surgical procedures and promote patient-centered outcomes through continued non-surgical maturation.
Improving periodontal regeneration outcomes with hyaluronic acid: A systematic review and meta-analysis.
Alrmali AE, Butt QO, Kassar R … +4 more , Hazrati P, Amrou Y, Sculean A, Wang HL
Periodontol 2000 · 2026 Jun · PMID 42334067 · Publisher ↗
OBJECTIVES: To evaluate the clinical and radiographic efficacy of the adjunctive use of hyaluronic acid (HA) in regenerative periodontal surgery for the treatment of intrabony defects. MATERIALS AND METHODS: A systematic...
OBJECTIVES: To evaluate the clinical and radiographic efficacy of the adjunctive use of hyaluronic acid (HA) in regenerative periodontal surgery for the treatment of intrabony defects. MATERIALS AND METHODS: A systematic search identified randomized controlled trials (RCTs) involving adult patients with intrabony defects who underwent regenerative periodontal surgery with adjunctive HA. The primary outcome was probing pocket depth (PPD) reduction; secondary outcomes included clinical attachment level (CAL) gain, gingival recession (REC), and radiographic defect depth (RDD) reduction. Meta-analysis according to the regenerative protocol was performed using random-effects models, with subgroup analyses. RESULTS: Fourteen RCTs met the inclusion criteria. Compared to controls, adjunctive HA resulted in an additional PPD reduction of approximately 0.7-1.2 mm and CAL gain of 0.7-1.1 mm, with more consistent effects at 12 months. Subgroup analyses indicated significant benefits when HA was applied alone or with membranes, whereas no added benefit was observed with bone substitute materials. Radiographic outcomes showed a favorable trend for HA, with an additional RDD reduction of about 0.7-1.0 mm, though heterogeneity was noted. Comparisons between HA and enamel matrix derivative (EMD) revealed comparable or slightly superior results for EMD. CONCLUSION: Adjunctive HA may enhance clinical and radiographic outcomes in intrabony defects when used in regenerative periodontal surgery, although heterogeneity and study quality warrant cautious interpretation of the findings.
Does adherence to supportive periodontal care lower the risk of caries and related tooth loss? A systematic review and meta-analysis.
Donnermeyer D, Meyer-Lückel H, Stähli A … +2 more , Cosgarea R, Wierichs RJ
Periodontol 2000 · 2026 Jun · PMID 42334057 · Publisher ↗
OBJECTIVES: The present systematic review critically summarizes the results of clinical studies investigating the risk of crown or root caries and tooth loss in adult patients suffering from periodontitis in relation to...
OBJECTIVES: The present systematic review critically summarizes the results of clinical studies investigating the risk of crown or root caries and tooth loss in adult patients suffering from periodontitis in relation to their adherence to supportive periodontal care (SPC). MATERIALS AND METHODS: Five electronic databases were searched for studies from 1947 to 2025. Odds ratios (or) were calculated for continuous outcome data (e.g., the number of new caries lesions or lost teeth) in a fixed or random-effects model. RESULTS: Thirty-nine articles, reporting 34 studies with 9685 patients at baseline with at least 157 779 teeth, were included. One study investigated the development of root caries at tooth level, 25 examined tooth loss at patient level, and 13 tooth loss at tooth level. A meta-analysis was not feasible for the outcome root caries. At patient level, significantly more less-adherent patients experienced tooth loss compared with adherent patients (OR = 1.50, 95% CI: 1.11-2.01). At tooth level, adherent patients showed significantly fewer lost teeth than less-adherent patients (OR = 1.64, 95% CI: 1.17-2.29). CONCLUSIONS: Adhering to SPC reduces the risk of tooth loss in periodontitis patients. In contrast, evidence on root caries prevention is limited, with only one study addressing this outcome. CLINICAL RELEVANCE: Prevention of caries and subsequent tooth loss is highly relevant for patients undergoing SPC. However, it remains insufficiently addressed in the current literature, underscoring the need for further well-designed studies investigating caries progression in periodontally compromised patients.
Long-term stability of periodontal plastic surgery featuring traditional autogenous graft and coronally advanced flap alone.
Zucchelli G, Mounssif I, Mazzotti C … +7 more , Bianchelli D, Bentivogli V, Marzadori M, Sangiorgi M, Zucchelli A, Mele M, Stefanini M
Periodontol 2000 · 2026 Jun · PMID 42298865 · Publisher ↗
BACKGROUND: Coronally advanced flap (CAF), either alone or in combination with a connective tissue graft (CTG), represents one of the most extensively investigated surgical approaches for the treatment of gingival recess...
BACKGROUND: Coronally advanced flap (CAF), either alone or in combination with a connective tissue graft (CTG), represents one of the most extensively investigated surgical approaches for the treatment of gingival recessions, demonstrating high rates of mean root coverage (MRC) and complete root coverage (CRC). However, evidence regarding their long-term performance remains limited. AIM: This review critically analyzes the long-term clinical performance of CAF alone and in combination with CTG, examining root coverage outcomes, stability of the gingival margin, keratinized tissue (KT), and gingival thickness (GT) gain, and esthetic integration over extended follow-up periods. The influence of baseline phenotype, surgical modifications, and specific clinical scenarios on long-term success is explored. MATERIAL AND METHODS: A comprehensive narrative review of randomized clinical trials (RCTs), controlled studies, case series, and retrospective cohorts with a minimum follow-up of 5 years was conducted. Outcomes were stratified by surgical technique (CAF vs. CAF + CTG), defect complexity, and follow-up duration (5 to >20 years). RESULTS: CAF alone demonstrates satisfactory short-term coverage but exhibits gradual apical relapse over time, particularly in inadequate phenotype. Long-term studies indicate progressive reduction of CRC, with stability strongly linked to early gingival margin position and phenotype maturity. In contrast, CTG adjunctive therapy consistently enhances long-term stability by increasing KT and GT, improving resistance to mechanical and biological relapse. According to the authors' experience, CTG is especially beneficial in anatomically or etiologically complex conditions. Extended follow-up (>20 years) confirms the enduring role of CTG-driven phenotype modification in preventing marginal relapse. CONCLUSIONS: Long-term success in root coverage procedures is predominantly phenotype-dependent. While CAF alone may be appropriate in selected sites with favorable anatomical and phenotypic features, CAF + CTG remains the gold standard for securing stable outcomes over time, particularly in challenging clinical scenarios. The drawbacks of applying CTG must be considered alongside the treatment benefits. CLINICAL RELEVANCE: Future therapeutic algorithms should incorporate a phenotype- and defect-driven approach to optimize the lifetime stability of periodontal plastic surgery outcomes.
Peri-implantitis-Is it mainly a clinician-initiated complication of implant therapy?
Chen ST, Monje A, Strauss FJ … +7 more , Schwarz F, Roccuzzo A, Sailer I, Tarnow D, Lambert F, Jovanovic S, Buser D
Periodontol 2000 · 2026 Jun · PMID 42253157 · Publisher ↗
AIM: The high prevalence of peri-implantitis is concerning, with a growing consensus that the majority of cases are complications initiated by clinician-related errors rather than classic pathology. A primary predisposin...
AIM: The high prevalence of peri-implantitis is concerning, with a growing consensus that the majority of cases are complications initiated by clinician-related errors rather than classic pathology. A primary predisposing factor for peri-implantitis is exposure of the micro-rough implant surfaces to the peri-implant sulcus after treatment. OBJECTIVES: To identify surgical/prosthetic factors causing micro-rough surface exposure and advocate for prevention and evidence-based protocols. MATERIALS AND METHODS: This paper reviews evidence linking surgical and prosthetic errors to micro-rough surface exposure to the sulcus and subsequent peri-implantitis development. RESULTS: Surgical factors for surface exposure include malposition, avascular necrosis, and incomplete bone regeneration of peri-implant defects. Prosthetic factors include cement remnants and wide prosthetic emergence angles. Clinician-influenceable co-factors-including patient compliance, history of periodontitis, uncontrolled systemic factors/habits, lack of keratinized mucosa, prosthetic misfit, overcontoured/uncleansable prostheses, failure to detect early bone loss or mucosal changes, and inadequate maintenance-contribute to the initiation and progression of peri-implantitis once micro-rough surfaces are exposed. CONCLUSIONS: Most peri-implantitis cases are preventable complications. Professional education and research must prioritize identifying clinician-related errors and adherence to foundational treatment principles. This requires a paradigm shift toward a complication-based model of peri-implantitis. CLINICAL RELEVANCE: To reduce the risk of peri-implantitis, clinicians should avoid clinical errors that lead to exposure of the micro-rough implant surface. Hybrid surface designs and subcrestal micro-rough surface placement should be considered as safety buffers. Success depends on meticulous diagnostics and planning, proper surgical/prosthetic execution, cleansable prosthesis design, and proactive maintenance to detect early bone loss and soft tissue changes.
Understanding exosomes in regenerative dentistry.
Ahmad P, Sculean A, Miron RJ
Periodontol 2000 · 2026 Jun · PMID 42220016 · Publisher ↗
BACKGROUND: Regenerative dentistry is shifting from cell-based strategies to cell-free biologics capable of orchestrating intricate tissue repair. Exosomes, nanosized extracellular vesicles carrying bioactive molecular p...
BACKGROUND: Regenerative dentistry is shifting from cell-based strategies to cell-free biologics capable of orchestrating intricate tissue repair. Exosomes, nanosized extracellular vesicles carrying bioactive molecular payloads, have emerged as central modulators of intercellular communication. This review aimed to offer a comprehensive synthesis of exosome-based regenerative processes across oral and craniomaxillofacial (CMF) tissues. METHODS: A structured literature review was performed utilizing PubMed, Scopus, and Web of Science databases without time restriction. Eligible studies included in vitro, in vivo, and clinical investigations assessing exosome-based mechanisms, molecular signaling pathways, and bioengineering approaches in regenerative dentistry. RESULTS: Exosomes derived from stem cells, immune cells, and dental tissues showed multifaceted regenerative impacts across periodontal, endodontic, orthodontic, and CMF applications. Mechanistically, exosomes mediated osteogenesis, angiogenesis, immune regulation, oxidative stress, and stem cell recruitment through central pathways, such as the PI3K/AKT, MAPK/ERK, Wnt/β-catenin, TGF-β/BMP, and NF-κB. They enhanced macrophage polarization toward anti-inflammatory phenotypes, restored osteoclast-osteoblast homeostasis, enhanced angiogenesis, and preserved mitochondrial homeostasis. In regenerative endodontics, exosomes enhanced cell viability, decreased apoptosis, and improved odontogenic differentiation and neurovascular coupling. In orthodontic and CMF regeneration, they coordinated mechanotransduction, osteogenesis, and angiogenesis. Bioengineering approaches, such as scaffold-mediated platforms, preconditioning, and genetic modification, further improved exosome stability, targeting, and treatment efficacy. CONCLUSION: Exosomes represent a versatile and robust cell-free treatment approach capable of orchestrating intricate oral tissue regeneration. Despite promising preclinical evidence, challenges associated with standardization, scalability, and clinical validation must be addressed to allow translation in routine dental practice.
Regenerative periodontal surgery and orthodontic therapy in the treatment of patients with stage IV periodontitis and pathologic tooth migration.
Jepsen K, Tietmann C, Proff P … +1 more , Jepsen S
Periodontol 2000 · 2026 May · PMID 42178740 · Publisher ↗
BACKGROUND: Patients suffering from stage IV periodontitis are often characterized by pathologic tooth migration, drifting, flaring, posterior bite collapse, and secondary occlusal trauma (case type 2). Many times, these...
BACKGROUND: Patients suffering from stage IV periodontitis are often characterized by pathologic tooth migration, drifting, flaring, posterior bite collapse, and secondary occlusal trauma (case type 2). Many times, these patients seek treatment because of functional and esthetic demands. The majority of these patients could benefit from an integrated, interdisciplinary approach combining periodontal therapy and orthodontics. MATERIALS AND METHODS: This narrative review aimed to update the scientific evidence on current treatment approaches for patients with stage IV case type 2, presenting with intrabony defects and pathological tooth migration. The strategic sequencing and timing of periodontal-regenerative surgery and orthodontic tooth movement are emphasized. RESULTS: Managing these patients is complex and requires careful coordination between periodontal and orthodontic specialists. Until recently, the timing of periodontal regeneration and orthodontic tooth movement has been unclear. However, new treatment guidelines and results from ongoing clinical research have provided new information. Based on the currently available evidence, it can be recommended that following a successful completion of steps 1 and 2 of periodontal therapy and regenerative periodontal surgery of intrabony defects using biomaterials according to current guideline recommendations at the migrated teeth, orthodontic tooth movement can be initiated as early as 4 weeks postoperatively. Provided patients maintain excellent oral hygiene and strictly adhere to an individualized supportive care program, favorable periodontal outcomes with significant improvements of their periodontal status can be expected with long-term stability up to 10 years. Moreover, this approach also leads to favorable orthodontic outcomes and does not increase the risk of external root resorption. These results were consistent regardless of the type of movement (translation, intrusion/extrusion, or buccal/lingual) or the type of biomaterial used. CONCLUSIONS AND CLINICAL RELEVANCE: Patients suffering from stage IV periodontitis with pathologic tooth migration requiring periodontal-regenerative therapy and orthodontic treatment can be successfully managed in the long term. The synergistic effects of a combined periodontal-regenerative and early orthodontic therapy have been demonstrated to result in a significantly improved oral health-related quality of life for patients, with restoration of function and esthetics.
Understanding exosomes in diabetic wound healing.
Ahmad P, Wang Y, Zhang Y … +2 more , Sculean A, Miron RJ
Periodontol 2000 · 2026 May · PMID 42178716 · Publisher ↗
BACKGROUND: Diabetic wounds signify a major complication of diabetes mellitus, characterized by chronic inflammation, compromised angiogenesis, and high risk of infection, amputation, and mortality. Contemporary therapie...
BACKGROUND: Diabetic wounds signify a major complication of diabetes mellitus, characterized by chronic inflammation, compromised angiogenesis, and high risk of infection, amputation, and mortality. Contemporary therapies remain limited in efficacy and durability. This review aimed to comprehensively assess exosome-mediated interventions as a cell-free regenerative approach for diabetic wound healing. METHODS: This narrative-scoping review was conducted using PubMed, Scopus, Web of Science, EMBASE, and Cochrane databases, identifying 176 preclinical and clinical studies. Included studies evaluated exosome origins, mechanisms of action, delivery platforms, and treatment outcomes in diabetic wound healing. RESULTS: Exosomes derived from mesenchymal stem cells, progenitor cells, blood products, immune cells, and natural sources consistently improved wound healing by enhancing angiogenesis, re-epithelialization, fibroblast proliferation, and extracellular matrix remodeling, while decreasing oxidative stress and chronic inflammation. Mechanistically, these effects were regulated via the stimulation of the PI3K/AKT, ERK/MAPK, STAT3, HIF-1α/VEGF, and Nrf2 signaling, together with the suppression of the AGE/RAGE-regulated ferroptosis and apoptosis. Biomaterial-based delivery systems, including scaffolds, microneedle patches, and hydrogels, significantly enhanced exosome retention, stability, and treatment efficacy. Across studies, exosome treatments showed expedited wound closure, enhanced collagen deposition, and improved vascularization in diabetic models. CONCLUSION: Exosome-mediated therapies represent a promising and multifaceted regenerative strategy for diabetic wound healing, addressing pivotal pathophysiological deficits. Nevertheless, challenges associated with standardization, scalability, and clinical validation must be resolved before widespread clinical application.
Implant therapy in older patients: Prosthetic considerations and biomechanical implications for frailty/aging.
Yeh YT, Chiou LL, Yoon D … +8 more , Lieuw K, Yang B, Maniewicz S, Zekeridou A, Curtis DA, Müller F, Hernandez-Kapila YL, Lin GH
Periodontol 2000 · 2026 May · PMID 42175573 · Publisher ↗
BACKGROUND: Population aging is reshaping prosthodontic care for both partially and completely edentulous individuals. In older adults, conditions such as frailty, comorbidities, polypharmacy, and cognitive decline can h...
BACKGROUND: Population aging is reshaping prosthodontic care for both partially and completely edentulous individuals. In older adults, conditions such as frailty, comorbidities, polypharmacy, and cognitive decline can have a direct impact on the biological and biomechanical demands of implant therapy, thereby influencing the success of implant treatment. MATERIALS AND METHODS: This narrative review synthesizes evidence on implant therapy in older patients, integrating prosthetic and biomechanical considerations with patient-related factors. The literature search addressed implant survival, complications, prosthetic and material design, peri-implant soft tissue considerations, and treatment options such as shortened dental arch approaches, implant-assisted removable partial dentures (IARPDs), implant overdentures, and complete dentures, as well as maintenance strategies with patient and caregiver education. RESULTS: Implant survival in older patients remains high, and age alone should not be considered as a limiting factor for implant treatment. Hygiene-oriented prosthetic designs, including non-mucosa-contact intaglio surfaces and emergence angles less than 30°, were associated with reduced plaque accumulation and peri-implant bone loss in older adults. While limited keratinized mucosa correlated with greater plaque and recession, phenotype modification should be evaluated on a case-by-case basis, carefully weighing the benefits against the surgical burden for the older patient. Ceramic materials accumulate less plaque as compared with processed acrylic resin, and veneered zirconia remained more prone to chipping than monolithic zirconia. Alternative treatment options-such as overdentures to enhance bite force, a shortened dental arch when posterior implants are contraindicated, or IARPDs to improve stability-may be especially appropriate for older patients with functional limitations. Caregiver participation and structured maintenance significantly reduce peri-implantitis risk. CONCLUSION: Implant therapy in older patients, including individuals aged 75 years and above, is highly feasible when age-related risks are addressed, prostheses are designed for cleansability and retrievability, and maintenance includes structured follow-up and caregiver support. CLINICAL RELEVANCE: Clinicians should emphasize functional goals, hygiene-accessible designs, pragmatic treatment alternatives, selective peri-implant soft tissue management when indicated, and personalized maintenance supported by patient and caregiver education.
Esthetical and patient-reported outcomes after root coverage procedures for multiple gingival recessions: A systematic review and meta-analysis.
Stefanini M, Mounssif I, Figuero E … +3 more , Zucchelli G, Sculean A, Cosgarea R
Periodontol 2000 · 2026 May · PMID 42130372 · Publisher ↗
BACKGROUND: Multiple gingival recessions can lead to esthetic impairments and may require surgical root coverage. Esthetic outcome measures can be assessed from both professional and patient perspectives. Several objecti...
BACKGROUND: Multiple gingival recessions can lead to esthetic impairments and may require surgical root coverage. Esthetic outcome measures can be assessed from both professional and patient perspectives. Several objective and subjective outcome measures have been applied for these evaluations. AIM: To systematically review and conduct a meta-analysis of the available literature on professional esthetic assessments and patient-related outcome measures (PROMs) following surgical root coverage procedures for the treatment of multiple gingival recessions. MATERIALS AND METHODS: A computerized systematic search was conducted in the MEDLINE (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials databases up to May 2024 to identify eligible studies meeting the inclusion criteria. RESULTS: A total of 32 randomized controlled trials involving 1012 patients and 3589 multiple gingival recessions were included. No case-series studies meeting the inclusion criteria were retrieved. Meta-analyses demonstrated that root coverage procedures statistically significantly improved both professionally assessed and patient-reported esthetic outcomes. The overall weighted mean Root Coverage Esthetic Score (RES) was 8.31 (95% CI: 8.11-8.50), with comparable results across coronally advanced flap (CAF) and tunnel (TUN) techniques, particularly when combined with autogenous connective tissue grafts or graft substitutes. Patient-reported esthetic satisfaction, measured primarily by visual analog scales (VAS), showed a pooled mean of 8.59 (95% CI: 8.29-8.89). Mean root coverage (MRC) reached 82.6% (95% CI: 71.3-93.9), and complete root coverage (CRC) was 62.7% (95% CI: 57.0-68.4). Statistically significant reductions in recession depth (mean difference = 2.22 mm) and gains in keratinized tissue (0.74 mm), gingival thickness (0.56 mm), and clinical attachment level (2.17 mm) were observed. Postoperative pain was low across techniques (VAS 0-10 mean: 2.67; VAS 0-100 mean: 24.34). Metaregression revealed a positive association between MRC and RES (R = 0.345) but no significant correlation between MRC and patient esthetic perception (R = 0.091), underscoring the divergence between clinical and patient-reported outcomes. CONCLUSIONS: The results of this systematic review and meta-analysis, focusing on multiple gingival recessions, suggest that (a) CAF and TUN with the adjunctive use of autogenous graft support esthetic improvement from both professional and patient perspectives and (b) CAF and TUN with the adjunctive use of autogenous graft or graft substitutes are effective in root coverage outcomes with a minimal postoperative morbidity.
Understanding exosomes in facial esthetics and skin aging.
Miron RJ, Davies C, Sculean A … +1 more , Ahmad P
Periodontol 2000 · 2026 May · PMID 42130348 · Publisher ↗
BACKGROUND: Skin aging is a multifactorial process mediated by intrinsic (genetic and metabolic) and extrinsic (environmental) factors leading to functional and structural deterioration, including wrinkles, loss of colla...
BACKGROUND: Skin aging is a multifactorial process mediated by intrinsic (genetic and metabolic) and extrinsic (environmental) factors leading to functional and structural deterioration, including wrinkles, loss of collagen and elastin, as well as various pigmentation disorders. Exosomes, the smallest subset of extracellular vesicles, have emerged as potent cell-free regulators of intercellular communication with significant regenerative potential. This scoping review synthesized available in vitro, in vivo, and clinical evidence investigating the role of exosomes in facial esthetics and skin rejuvenation. METHODS: A comprehensive literature search was conducted up to January 2nd, 2026, using PubMed, Scopus, Web of Science, and Google Scholar. Search terms included ((extracellular vesicle) OR (exosome)) AND ((esthetic) OR (aesthetic) OR (rejuvenation)). All in vitro, in vivo, and human clinical studies were included without restriction. RESULTS: A total of 54 studies (from 472 records) were included: 27 in vitro, 16 in vivo, and 29 clinical studies (several overlap). In vitro outcomes demonstrated that exosomes improved cell viability, proliferation, and migration, while enhancing extracellular matrix formation (collagen, elastin, fibronectin) and upregulating antiaging-associated gene expression. These impacts were accompanied by alleviated inflammation, oxidative stress, and regulation of senescence and autophagic signaling. Animal research supported these outcomes, showing enhanced fat graft retention, improved angiogenesis, facilitated dermal remodeling, and epidermal thickening, together with expedited wound repair and reduced expression of matrix metalloproteinases and inflammatory regulators. Clinical studies consistently report decreases in wrinkles, pore size, erythema, scarring, and hyperpigmentation, along with improved skin elasticity, texture, hydration, and thickness. Both patient-reported and clinician-assessed outcomes, including the Global Aesthetic Improvement Scale, demonstrate positive outcomes. Additional advantages included decreased acne severity, shorter recovery times, and fewer adverse effects. CONCLUSIONS: Exosomes showed substantial regenerative potential in facial esthetics and skin antiaging. Nevertheless, heterogeneity in study methodologies and the limited number of high-quality RCTs require further well-designed studies to establish optimized protocols and ensure long-term efficacy and safety.
From senescence and inflammaging to systemic comorbidities: Drivers of aging-associated periodontitis.
Cheng J, Aung CTZ, Suslavich SF … +2 more , Sahingur SE, Hernandez-Kapila YL
Periodontol 2000 · 2026 May · PMID 42101083 · Publisher ↗
BACKGROUND: Aging is accompanied by a chronic low-grade inflammatory process, known as inflammaging, as well as immunosenescence, an age-related decline and dysregulation of immune function, and cellular senescence, a pr...
BACKGROUND: Aging is accompanied by a chronic low-grade inflammatory process, known as inflammaging, as well as immunosenescence, an age-related decline and dysregulation of immune function, and cellular senescence, a process in which cells enter a state of irreversible growth arrest while actively releasing pro-inflammatory factors. These processes alter the host immune regulation and tissue homeostasis. Aging-associated mechanisms are being explored for their role in periodontal and peri-implant diseases because of their promotion of dysregulated inflammation, impaired healing, and heightened susceptibility to tissue destruction. Rather than viewing periodontitis as a condition driven solely by microbial burden, it should be understood as a multifactorial disease shaped by complex host-microbe interactions, in which host-driven processes, particularly senescence and inflammaging, play a central role in amplifying bidirectional oral-systemic interactions. AIM: This scoping review aims to (i) highlight the current understanding of the role of aging and its alterations in host inflammatory responses on immune function, tissue homeostasis, and cellular stress responses; (ii) explore the potential impact of "inflammaging" on the periodontium and interactions with systemic health; and (iii) explore possible therapeutic targets for senotherapy. 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 aging and inflammation in the context of the oral cavity. RESULTS: Of the total 283 articles that were screened, 87 met the eligibility criteria and were included in this scoping review. An additional 51 articles were obtained via manual search. The evidence demonstrates a link between inflammaging, age-related cellular senescence, and periodontal vulnerability to periodontal pathogens and periodontal destruction. Both experimental and clinical studies have shown increased senescence markers, dysregulated immune responses, and enhanced osteoclastic activity that lead to greater tissue destruction and alveolar bone loss. Systemic conditions such as Alzheimer's disease, diabetes, and cardiovascular disease can also amplify the inflammatory burden through shared pathways. Overall, our findings support the idea that older adults undergo immune dysregulation when challenged with microbes that ultimately cause a chronic periodontal inflammatory state.
Educational methods for implementation of proper oral hygiene behavior prior, during, and after orthodontic therapy of patients with periodontal problems.
Tan HJ, Makropoulos T, Suvan J
Periodontol 2000 · 2026 Apr · PMID 42032439 · Publisher ↗
BACKGROUND: Periodontitis complicates orthodontic treatment due to compromised periodontal support and heightened susceptibility to inflammation. Effective plaque control is essential before, during, and after orthodonti...
BACKGROUND: Periodontitis complicates orthodontic treatment due to compromised periodontal support and heightened susceptibility to inflammation. Effective plaque control is essential before, during, and after orthodontic intervention to maintain periodontal stability and prevent disease recurrence. METHODS: This narrative review explores evidence surrounding the importance of oral hygiene instruction (OHI), patient motivation, and behavior change strategies in managing ortho-perio patients. RESULTS: Evidence suggests that behavior change is complex and knowledge alone is insufficient to maintain long-term self-care without clinician support and patient engagement. Individually tailored OHI, combined with patient-centered communication, can foster sustainable self-care habits. Ortho-perio oral hygiene routines are unique considering periodontal status and evolve alongside changes in orthodontic appliances. Emphasis should consistently be on four critical areas: the gingival margins, interproximal spaces, orthodontic brackets and archwires, and fixed retainers. CONCLUSION: Orthodontic treatment in patients with periodontitis is a dynamic process with constant oral environment changes. Ongoing personalized education and behavior change strategies tailored to treatment stage and periodontal risk are essential to support patient self-care and ensure long-term oral health. CLINICAL RELEVANCE: A multidisciplinary approach from periodontal and orthodontic clinicians, involving ongoing education, customized hygiene strategies, and behavior support, is critical to achieving optimal treatment outcomes in ortho-perio patients.
Effectiveness of nonsurgical therapy of peri-implant mucositis: A systematic review.
Brunello G, Antonelli A, Schulze-Späte U … +2 more , Correia F, Becker K
Periodontol 2000 · 2026 Apr · PMID 42032437 · Publisher ↗
OBJECTIVES: This systematic review intends to respond to the question: "How do clinical parameters change in implants affected by peri-implant mucositis following different non-surgical treatment approaches or no treatme...
OBJECTIVES: This systematic review intends to respond to the question: "How do clinical parameters change in implants affected by peri-implant mucositis following different non-surgical treatment approaches or no treatment in patients monitored for a minimum of six months?" MATERIALS AND METHODS: A search for randomized clinical trials (RCTs) or prospective controlled clinical studies (NRCT) in MEDLINE-PubMed, Cochrane Central Register of Controlled Trials, and Web of Science was performed between May 2015 and April 2025. After a two-step screening, data extraction and risk of bias (RoB) assessment were performed. A network meta-analysis (NMA), incorporating multi-arm RCTs, was planned. RESULTS: Twenty-one studies (19 RCTs; 2 NRCTs; 1068 patients) were included. The treatments comprised curettes, (ultra)sonic scalers, air-polishing, laser, antimicrobials, probiotics, and antibiotics, alone or in combination. Patient-related systemic and local factors and operator-related factors were sporadically reported and analyzed. To various extents all treatments resulted in a reduction in BOP. When reported, peri-implant mucositis resolution was achieved in a subset of patients, ranging from 9% to 100% (only in one study group). Microbiological and immunological data and patient-reported outcomes (PROs) were sparsely and heterogeneously reported. Only one-third of the studies presented low RoB. Due to limited data available and heterogeneity in treatment protocols and outcomes among the included studies, a NMA could not be performed. CONCLUSIONS: Within the limitations of this review, different nonsurgical treatment protocols, including mechanical debridement alone, all improved clinical parameters, whereas adjuncts yielded only minor improvements after 6 months. Standardized outcome sets and routine PROs are needed to improve comparability and decision-making in future studies.
Marginal bone loss around implants - What does it mean?
Dionigi C, Bougas K, Berglundh T … +1 more , Derks J
Periodontol 2000 · 2026 Apr · PMID 42032222 · Publisher ↗
BACKGROUND: Changes in peri-implant marginal bone levels (MBL) constitute a central outcome in studies on implant therapy and reflect the integrity of the supporting tissues over time. AIM: To summarize current evidence...
BACKGROUND: Changes in peri-implant marginal bone levels (MBL) constitute a central outcome in studies on implant therapy and reflect the integrity of the supporting tissues over time. AIM: To summarize current evidence on MBL changes around dental implants, with emphasis on temporal patterns, methods of assessment and their clinical interpretation. MATERIALS AND METHODS: This narrative review is based on a targeted screening of the literature, including pre-clinical investigations, observational studies and clinical trials reporting radiographically assessed MBL changes. Population-based datasets and randomized controlled trials were prioritized. RESULTS: The available evidence indicates that most MBL change occurs during the early phases following implant installation and abutment connection and typically does not exceed 1 mm, reflecting physiological remodeling. After prosthetic loading, further MBL alterations are generally also limited, commonly within a range of 0.1-0.3 mm during the first year of function and minimal changes thereafter. Radiographic methods are most frequently used for MBL assessment, with reported measurement errors in the order of ≤0.5 mm. While mean MBL changes are small in most studies, analyses of distributions show that approximately 15-25% of implants present with bone loss exceeding 1 mm, whereas only a smaller proportion exhibits pronounced bone loss. CONCLUSIONS: MBL changes over time are limited at the majority of dental implants. These alterations represent the cumulative effects of biological, mechanical and host-related factors. The interpretation of MBL changes should consider methodological aspects of assessment and reporting, as well as their relationship to peri-implant diseases. Progressive bone loss constitutes a defining feature of peri-implantitis.
Population level data on aging in periodontal and peri-implant health-Aging is not a contraindication for periodontal or peri-implant therapy.
Yang D, Chang J, Huang S … +1 more , Kapila YL
Periodontol 2000 · 2026 Apr · PMID 42031692 · Publisher ↗
OBJECTIVES: Global population aging is leading to a greater retention of natural teeth into later life and an increasing prevalence of dental implant therapy. Although advanced age has traditionally been regarded as a ri...
OBJECTIVES: Global population aging is leading to a greater retention of natural teeth into later life and an increasing prevalence of dental implant therapy. Although advanced age has traditionally been regarded as a risk factor for compromised outcomes, population level evidence remains lacking. This review synthesizes large-scale clinical and population-level studies to evaluate whether chronological age constitutes a genuine limiting factor for periodontal and implant treatment. MATERIALS AND METHODS: This review compared tooth loss rates, periodontal soft and hard tissue status, and treatment outcomes between younger and older cohorts. Regarding implant therapy, the assessment primarily evaluated success and survival rates across various time periods, peri-implant bone loss, relevant clinical parameters, as well as implant allergies, peri-implantitis, and peri-implant mucositis. Furthermore, data on orthopedic implants were analyzed to provide a comparative perspective on age-related biomaterial integration. RESULTS: Periodontal treatments remain significantly effective, although outcomes of non-surgical periodontal therapy vary among different age groups. Surgical periodontal therapy outcomes show no significant age-related differences. Advanced age is not consistently associated with higher implant failure rates. Several studies report comparable or even higher survival rates in older patients. Marginal bone loss and probing depths are similar across age groups. Orthopedic implant literature similarly shows that age alone does not preclude successful outcomes. CONCLUSIONS: Aging is not a contraindication for periodontal or implant therapy and is not a default risk factor for failure. Thorough evaluation of systemic health and individualized treatment planning are more critical for overall treatment success than a patient's chronological age.
Oral health-related quality of life (OHRQoL) in people with dentin hypersensitivity: A systematic review of interventional studies.
Kitsaras G, Bekes K, Kumbargere S … +2 more , Randall CL, Asimakopoulou K
Periodontol 2000 · 2026 Apr · PMID 42031690 · Publisher ↗
OBJECTIVE: This systematic review, the first in this field, aimed to evaluate if interventions for dentin hypersensitivity (DH) affect patient-reported oral health-related quality of life (OHRQoL). METHODS: A systematic...
OBJECTIVE: This systematic review, the first in this field, aimed to evaluate if interventions for dentin hypersensitivity (DH) affect patient-reported oral health-related quality of life (OHRQoL). METHODS: A systematic search was conducted across seven electronic databases and gray literature sources, focusing on interventional studies published from 2010 onward. Eligible studies included adult participants with DH and assessed OHRQoL using validated measures. Data extraction followed the PRISMA guidelines. Risk of bias was appraised using the JBI tool. RESULTS: Thirteen randomized controlled trials involving 616 participants were included. Interventions ranged from desensitizing agents, fluoride varnishes, and laser therapy to nonpharmacological approaches like behavioral techniques. QoL was measured primarily using OHIP-14 and DHEQ-15 tools. The certainty of evidence was rated as very low due to risks of bias, inconsistency, and imprecision. CONCLUSIONS: Key findings from this review can help shape the way we understand, quantify, and explore QoL in patients diagnosed with DH. Although several interventions showed promise in reducing DH symptoms and improving QoL, the current evidence base is methodologically limited and inconsistent. High-quality studies using standardized, validated patient-reported outcome measures are needed. Clinical management of DH should incorporate assessment of OHRQoL to guide holistic, patient-centred care.
Long-term stability of vertical bone augmentation in implant dentistry: A domain-based review.
Urban I, López-Galindo PA, Hasheminasab M … +5 more , Baniameri S, Cucchi A, Saleh M, Felice P, Ravidà A
Periodontol 2000 · 2026 Apr · PMID 42031688 · Publisher ↗
OBJECTIVES: Vertical ridge deficiency remains one of the most challenging conditions in preimplant surgery. Several techniques aim to restore lost vertical alveolar height, each with specific indications and limitations....
OBJECTIVES: Vertical ridge deficiency remains one of the most challenging conditions in preimplant surgery. Several techniques aim to restore lost vertical alveolar height, each with specific indications and limitations. Although these procedures often yield favorable short-term outcomes with stable bone levels, their long-term performance is crucial for determining true clinical value. MATERIALS AND METHODS: A systematic search of three databases identified 614 records, of which 35 studies met the eligibility criteria of a minimum of 5 years of follow-up that performed vertical ridge augmentation. This review applied a domain-based evaluation framework derived from the Implant Dentistry Core Outcome Set and Measurement (ID-COSM) and the Bone Augmentation Core Outcome Set (BA-COSM). Implant survival and marginal bone loss were synthesized using random-effects models with inverse-variance weighting, with analyses stratified by follow-up duration and vertical ridge augmentation approach. RESULTS: Implants placed in vertically augmented bone showed high long-term success, with survival rates of 96% at 5 years, 94% at 10 years, 98% at 15 years, and 95% at 20 years. Marginal bone levels remained stable, with a mean bone loss of 0.67 mm at 5 years and 0.72 mm at 10 years, 1.52 mm at 15 years and 1.53 mm at 20 years. CONCLUSIONS: Vertical ridge augmentation techniques support predictable implant survival and bone stability. However, heterogeneous reporting of outcomes limits comparability. A standardized, domain-based framework enhances evidence synthesis and clinical relevance in implant dentistry.
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