Dentistry Review最新文献

Primary Sjögren syndrome (pSS) is a chronic autoimmune disease mainly affecting salivary and lacrimal glands. The current pSS biomarkers, serum autoantibodies, are negative in many pSS patients diagnosed with histopathology changes, indicating the need of novel biomarkers. The current therapies of pSS are merely short–term symptomatic relief and can't provide effective long–term remedy. Extracellular vehicles (EVs) are nano–sized lipid bilayer–delimited particles spontaneously released by almost all types of cells and carrying various bioactive molecules to mediate inter–cellular communications. Recent studies found that EVs from salivary gland epithelial cells and immune cells play essential roles in pSS pathogenesis. Correspondingly, EVs and their cargos in plasma and saliva are promising candidate biomarkers for pSS diagnosis. Moreover, EVs from mesenchymal stem cells have shown promises to improve pSS treatment by modulating immune responses. This review summarizes recent findings in roles of EVs in pSS pathogenesis, diagnosis, and treatment of pSS, as well as related challenges and future research directions.

Introduction

Pigmented lesions in the oral cavity mucosa, primarily found in African, Asian, and Mediterranean populations, are caused by increased melanin granule production or melanocyte abundance. These lesions typically appear in childhood and increase with age. This study aimed to evaluate, based on the evidence in the literature, the efficacy of diode laser in the treatment of physiological gingival melanosis in terms of clinical and aesthetic variables, based on the patient, compared to conventional surgical therapy such as the scalpel technique.

Materials and methods

Electronic databases (PubMed, Web of Science and Scopus) were examined in March 2024, in the last 10 years. We performed a manual screening of the reference lists of potential studies. The risk of bias was measured with the ROBINS tool.

Results

The search found 840 publications, but 40 of them were duplicates and were therefore excluded. Titles and abstracts of 800 articles were accessed and 646 were excluded. After applying the inclusion and exclusion criteria, we included 12 studies out of the remaining 154. Data were collected from the selected articles and organized into tables for comparison and study.

Conclusions

The diode laser obtained better results in terms of intraoperative bleeding and perception of pain for the patient. However, there were no differences in depigmentation and wound healing intensity. Due to the small research samples and the heterogeneity of the data provided, more studies with a high degree of scientific relevance and with a clear research protocol are needed.

Peri-implant buccal soft tissue dehiscences (BSTD) not only impact the aesthetic appearance of the implant- restorations but also pose a threat to the long-term survival of the implants. This comprehensive narrative review aims to provide a concise overview of the epidemiology, classification, risk indicators, current surgical and prosthetic therapeutic approaches of peri‑implant BSTD. Although BSTD is a common finding, the different study design, case definitions and follow-up periods difficult the estimation of a representative prevalence. Implants placed too buccal and thin peri‑implant phenotype are viewed as the major factors associated with the occurrences of BSTD. The most reported and scientifically-supported surgical technique is coronally advanced flap plus connective tissue graft, although other surgical techniques have been evaluated in the long-term. Further randomized clinical trials are needed to assess the efficacy of each surgical technique in the management of BSTD.

Mucogingival surgery encompasses any procedure designed to correct defects in the morphology, position, or enhance the dental gingival junction. The lack of keratinized gingiva and the presence of gingival recession can be an esthetic and functional problem for the patient. This paper will review the gingival dimensions of the periodontium in health and address the prevalence, etiology, and predisposing factors related to defects in the quality and quantity of gingiva.

Gingival augmentation techniques and indications will be reviewed, including root coverage and non-root coverage procedures. Autogenous soft tissue grafts will be described, as well as several non-autogenous graft materials.

Ultimately, careful diagnosis, realistic expectations, clear goals, and correct technique selection are essential for the most successful clinical results.

Periodontal diseases encompass a wide variety of conditions, mostly related to biofilm accumulation while others may develop independently of it. Mucogingival deformities and around teeth, and peri‑implant soft tissue deficiencies are some of the most common conditions that we need to treat in our daily practice.

Immediate tooth-replacement therapy can be a predictable method for treating anterior hopeless teeth. Preserving and augmenting both hard and soft tissues is critical for the physiologic and esthetic success of therapy. Utilizing a combined hard and soft tissue augmentation approach improves outcomes. Reducing morbidity associated with procuring autogenous grafts can be efficacious regarding short and long-term outcomes. The Dermal Apron Technique uses both bone and soft tissue allografts to increase soft tissue thickness around immediately placed and provisionalized implants. Studies demonstrate the increased soft tissue thickness produced by the technique. This article demonstrates the technique and discusses the clinical research supporting the use of this method for successful immediate tooth-replacement therapy.

Our objectives of this narrative review is to summarize the scientific perspective on the effect of periodontal disease on age-related diseases, focusing on chronic low-level systemic inflammation, and discuss the goals for future research. In this review, we summarized the findings of articles that showed the mechanisms of periodontal disease and each age-related disease. Periodontal disease is a prevalent infectious disease due to oral anaerobic bacteria that results in dissolution of the gums around the teeth (gingiva) and the bone supporting the teeth, leading to decreased quality of life. The disease is more prevalent with increasing age and associated with age-related diseases, such as diabetes, non-alcoholic fatty liver disease, cardiovascular disease, dementia, and osteoporosis via chronic low-level systemic inflammation, which requires long-term care and increases medical costs. Chronic low-level systemic inflammation due to periodontal disease is a common risk factor for age-related diseases, but the mechanisms of inflammation in each disease vary. Periodontal pathogens mainly cause three patterns of inflammation: cytokine crosstalk that attacks the whole body, changes in the balance of gut microbiota, and production of proteases like gingipains that can subvert immune responses to reach various systemic organs, especially the brain. Several age-related diseases, such as diabetes and dementia, can be improved by treating periodontal disease as inflammatory markers are reduced. In conclusion, it will be necessary to confirm whether the exact mechanism in the human body is the same as that in mice. Improvement in chronic low-level systemic inflammation caused by periodontal disease may be effective in the treatment of age-related diseases.

The peri‑implant mucosa (PIM) is formed during the wound healing process that follows implant and abutment placement. The PIM is known to play crucial roles in function; acting as a biologic barrier for bacterial infiltration and maintaining the mucosal health of the implant, and for implant esthetics. This narrative review presents:

• Differences between periodontal soft tissue attachment and peri‑implant mucosal tissue attachment

• Development of the osseointegration and its effect on PIM

• Different Implant – abutment interface configurations including one– VS two-piece implants, bone-level VS tissue-level implants, and PIM in different implant collars

• Engineering in surface characteristics

Gingival recession is a prevalent mucogingival deformity and condition associated with teeth, often occurring in patterns involving multiple adjacent sites. This presentation by the patient is frequently framed as an aesthetic concern, because of the imbalance in white and pink esthetic proportions, or related to a complaint of dentin hypersensitivity. The clinician is required to understand the etiologic factors specific to this recession pattern. Modification or management of these factors contributing to multiple adjacent gingival recession should be included as part of the overall treatment plan to increase efficacy of surgical root coverage procedures. The current treatment options for multiple gingival recession include tunneling and coronally advanced flap techniques with varying technical modifications. The aim of this narrative review is to explore the development of these procedures utilized to manage patients presenting with multiple adjacent gingival recession.

This review assesses evolving landscape of mucogingival surgery for treatment of gingival recession and peri-implant mucosal defects, highlighting an increased awareness of the role of soft tissue and advancements in treatment modalities. In response to diverse mucogingival defects, various treatment approaches have been proposed, with ongoing updates in considerations, prognostic factors, as well as the introduction of novel techniques. A comprehensive and up-to-date exploration of the existing literature is therefore required to consolidate the current understanding of mucogingival surgery.

Among all treatment modalities, coronally advanced flap (CAF) and tunneling (TUN) techniques were evaluated for treating gingival recessions and peri-implant mucosal defects, acknowledging challenges due to limited direct comparisons and heterogeneous study groups. While some evidence favored CAF for achieving higher complete root coverage, recent meta-analyses suggest comparable outcomes for both techniques, underscoring the need for better-designed studies.

In conclusion, both CAF and TUN exhibit versatility in mucogingival surgery, with considerations for specific clinical scenarios. Future studies should explore surgical duration, post-operative experiences, and comprehensive outcomes such as patient satisfaction, long-term stability, and esthetic results for a more thorough evaluation of these techniques.