Yasir Nabeel Al‐Mohammad, Caroline Kelly, Petrana Martinekova, Alexander Schulze Wenning, Szilvia Kiss‐Dala, Noémi Gede, Beáta Kerémi, Zsolt Németh, Péter Hermann, László Márk Czumbel, Krisztina Mikulás, Péter Hegyi, Anton Sculean, Gábor Varga
Hundreds of millions of people have one or more missing teeth. Consequently, a substantial number of patients undergo implant therapy each year. However, technical complications and soft tissue inflammation associated with the implant abutment or the type of restoration can lead to bone loss and, ultimately, implant failure. Using the methodology of network meta‐analysis to rigorously compare and contrast the clinical performance of the three commonly used abutment materials: titanium (Ti), zirconium (Zr), and polyetheretherketone (PEEK) polymer. Until May 2025, a systematic search was performed in MEDLINE (PubMed), EMBASE, Scopus, and CENTRAL to find clinical studies comparing Ti, Zr, and PEEK implant abutments. Case reports, case series, in vitro, and in vivo studies were excluded. The Risk of Bias Tool 2, ROBINS‐I, and GRADE approaches were used for quality and certainty assessment. Thirty‐four articles (950 patients) were included, with various follow‐ups. All abutments had high survival rates and no significant differences in marginal bone loss (BL), probing depth (PD), bleeding on probing (BOP), and plaque index (PI). There was no significant difference between Zr and Ti for papillary index (PAP), with a general trend toward better results in Zr, which may be of clinical significance. There was a statistically significant difference in soft tissue discoloration (ΔE) values and technical complications of Zr versus Ti [MD: −2.03, CI: −3.89 to −0.18] and [OR: 0.26, CI: 0.09 to 0.72], respectively, indicating better esthetics and fewer technical complications in Zr. Both Ti and Zr are clinically successful and biologically acceptable. PEEK abutments demonstrated comparable characteristics with both Ti and Zr. However, more studies about PEEK and cost‐effectiveness analyses should also be performed to find the best options for clinical applications. PEEK can be a good alternative to Ti and Zr abutments for single‐tooth replacement in the anterior and premolar regions.
{"title":"Zirconia, titanium, and polyetheretherketone implant abutments show equal long‐term clinical success—A systematic review and network meta‐analysis","authors":"Yasir Nabeel Al‐Mohammad, Caroline Kelly, Petrana Martinekova, Alexander Schulze Wenning, Szilvia Kiss‐Dala, Noémi Gede, Beáta Kerémi, Zsolt Németh, Péter Hermann, László Márk Czumbel, Krisztina Mikulás, Péter Hegyi, Anton Sculean, Gábor Varga","doi":"10.1111/prd.70018","DOIUrl":"https://doi.org/10.1111/prd.70018","url":null,"abstract":"Hundreds of millions of people have one or more missing teeth. Consequently, a substantial number of patients undergo implant therapy each year. However, technical complications and soft tissue inflammation associated with the implant abutment or the type of restoration can lead to bone loss and, ultimately, implant failure. Using the methodology of network meta‐analysis to rigorously compare and contrast the clinical performance of the three commonly used abutment materials: titanium (Ti), zirconium (Zr), and polyetheretherketone (PEEK) polymer. Until May 2025, a systematic search was performed in MEDLINE (PubMed), EMBASE, Scopus, and CENTRAL to find clinical studies comparing Ti, Zr, and PEEK implant abutments. Case reports, case series, in vitro, and in vivo studies were excluded. The Risk of Bias Tool 2, ROBINS‐I, and GRADE approaches were used for quality and certainty assessment. Thirty‐four articles (950 patients) were included, with various follow‐ups. All abutments had high survival rates and no significant differences in marginal bone loss (BL), probing depth (PD), bleeding on probing (BOP), and plaque index (PI). There was no significant difference between Zr and Ti for papillary index (PAP), with a general trend toward better results in Zr, which may be of clinical significance. There was a statistically significant difference in soft tissue discoloration (ΔE) values and technical complications of Zr versus Ti [MD: −2.03, CI: −3.89 to −0.18] and [OR: 0.26, CI: 0.09 to 0.72], respectively, indicating better esthetics and fewer technical complications in Zr. Both Ti and Zr are clinically successful and biologically acceptable. PEEK abutments demonstrated comparable characteristics with both Ti and Zr. However, more studies about PEEK and cost‐effectiveness analyses should also be performed to find the best options for clinical applications. PEEK can be a good alternative to Ti and Zr abutments for single‐tooth replacement in the anterior and premolar regions.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"25 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145651141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of the paper was to present the potential for alveolar bone regeneration following the autotransplantation of immature teeth, based on a literature review and case presentations. Surgical treatment planning for successful healing is discussed with regard to donor selection, the stage of root development, the morphology and position of the donor tooth and the size of the apical foramen. The follow-up observations include pulp healing, the regeneration of Herwig's epithelial root sheath and periodontal healing. Differences between unerupted and erupted teeth, as well as the role of a dental follicle during the surgical removal of the donor tooth were discussed. Additionally, the changes associated with tooth eruption and the role of the periodontal ligament (PDL) in promoting bone formation after the autotransplantation of immature teeth were described. By utilizing the natural healing capacity of the PDL, autotransplantation represents a valuable treatment option for restoring dentition and promoting alveolar bone regeneration in patients with missing teeth or dental anomalies. Clinical and radiological documentation, along with the treatment descriptions of three young orthodontic patients illustrate the concepts discussed provide clinical guidelines for the autotransplantation of immature teeth.
{"title":"Alveolar bone regeneration after transplantation of immature teeth in orthodontic patients.","authors":"E Czochrowska,P Plakwicz","doi":"10.1111/prd.70023","DOIUrl":"https://doi.org/10.1111/prd.70023","url":null,"abstract":"The aim of the paper was to present the potential for alveolar bone regeneration following the autotransplantation of immature teeth, based on a literature review and case presentations. Surgical treatment planning for successful healing is discussed with regard to donor selection, the stage of root development, the morphology and position of the donor tooth and the size of the apical foramen. The follow-up observations include pulp healing, the regeneration of Herwig's epithelial root sheath and periodontal healing. Differences between unerupted and erupted teeth, as well as the role of a dental follicle during the surgical removal of the donor tooth were discussed. Additionally, the changes associated with tooth eruption and the role of the periodontal ligament (PDL) in promoting bone formation after the autotransplantation of immature teeth were described. By utilizing the natural healing capacity of the PDL, autotransplantation represents a valuable treatment option for restoring dentition and promoting alveolar bone regeneration in patients with missing teeth or dental anomalies. Clinical and radiological documentation, along with the treatment descriptions of three young orthodontic patients illustrate the concepts discussed provide clinical guidelines for the autotransplantation of immature teeth.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"368 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicola Alberto Valente,Salvatore D'Amato,Mauro Farella
After somatic growth ceases, craniofacial remodeling continues throughout adulthood, and teeth maintain a slow but persistent tendency to erupt. These ongoing skeletal and dental changes contribute to the progressive infraocclusion of dental implants. Our aim was to critically evaluate the evidence on late facial growth and continuous dentoalveolar eruption, and their implications for timing, risk assessment, and management of dental implants. A critical review of the current literature was conducted, focusing on longitudinal studies, clinical trials, and systematic reviews addressing residual facial bone remodeling, dentoalveolar eruption, and implant infraocclusion. Particular attention was given to patient-specific factors and patient-reported outcomes. Late craniofacial growth and continuous eruption of natural teeth contribute to spatial discrepancies between implants and adjacent dentition, even in skeletally mature adults. Younger age, increased anterior facial height, hyperdivergent facial patterns, and high smile lines were identified as key risk factors for implant infraocclusion. While delaying implant placement may reduce the risk of infraocclusion, there is no clear age threshold beyond which implants are entirely stable. Certain surgical techniques and prosthetic designs may mitigate long-term infraocclusion, and alternative treatments such as orthodontic space closure or adhesive bridges may provide a viable solution in selected cases. Progressive infraocclusion of implants is a multifactorial phenomenon influenced by residual craniofacial growth and alveolar changes. A thorough understanding of these biological processes and associated risk factors is essential to guide clinicians in selecting the optimal timing for implant placement and in considering alternative treatment strategies when appropriate. An evidence-based, patient-centered approach can help improve long-term functional and aesthetic outcomes, as well as patient satisfaction.
{"title":"Late facial growth and continuous dentoalveolar eruption: Implications for optimal dental implant placement.","authors":"Nicola Alberto Valente,Salvatore D'Amato,Mauro Farella","doi":"10.1111/prd.70024","DOIUrl":"https://doi.org/10.1111/prd.70024","url":null,"abstract":"After somatic growth ceases, craniofacial remodeling continues throughout adulthood, and teeth maintain a slow but persistent tendency to erupt. These ongoing skeletal and dental changes contribute to the progressive infraocclusion of dental implants. Our aim was to critically evaluate the evidence on late facial growth and continuous dentoalveolar eruption, and their implications for timing, risk assessment, and management of dental implants. A critical review of the current literature was conducted, focusing on longitudinal studies, clinical trials, and systematic reviews addressing residual facial bone remodeling, dentoalveolar eruption, and implant infraocclusion. Particular attention was given to patient-specific factors and patient-reported outcomes. Late craniofacial growth and continuous eruption of natural teeth contribute to spatial discrepancies between implants and adjacent dentition, even in skeletally mature adults. Younger age, increased anterior facial height, hyperdivergent facial patterns, and high smile lines were identified as key risk factors for implant infraocclusion. While delaying implant placement may reduce the risk of infraocclusion, there is no clear age threshold beyond which implants are entirely stable. Certain surgical techniques and prosthetic designs may mitigate long-term infraocclusion, and alternative treatments such as orthodontic space closure or adhesive bridges may provide a viable solution in selected cases. Progressive infraocclusion of implants is a multifactorial phenomenon influenced by residual craniofacial growth and alveolar changes. A thorough understanding of these biological processes and associated risk factors is essential to guide clinicians in selecting the optimal timing for implant placement and in considering alternative treatment strategies when appropriate. An evidence-based, patient-centered approach can help improve long-term functional and aesthetic outcomes, as well as patient satisfaction.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"245 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maud Joosstens, Cees Valkenburg, Fridus Van der Weijden
Maintaining optimal oral hygiene is important for overall oral care, ensuring the well‐being of teeth and their surrounding tissues. In addition, it promotes fresh breath and a pleasing smile. A key element of oral self‐care is the daily use of toothpaste during regular brushing. This plays an important role in preventing tooth decay and addressing broader oral health concerns like periodontal diseases. Toothpaste ingredients offer significant benefits to oral health, particularly stannous fluoride, which contributes to the efficacy of toothpaste formulations by demonstrating notable anticariogenic and antibacterial properties. However, toothpaste has potential side effects, such as those caused by flavoring, and sodium lauryl sulfate, a foaming agent known for its potential to irritate mucous membranes. Beyond toothpaste, the integration of mouthwash into daily oral care routines offers the potential to further improve overall oral hygiene. Chlorhexidine in mouthwash formulations stands out as an active ingredient that is highly effective. This paper investigates the effects of chemical plaque inhibitors where possible through comprehensive systematic evaluations of existing literature. It aimed to provide an understanding of how chemical agents used in oral self‐care contribute to promoting and maintaining optimal oral hygiene.
{"title":"Chemical agents to control biofilm formation in step 1 of care—Toothpastes and mouthwashes/concepts and challenges","authors":"Maud Joosstens, Cees Valkenburg, Fridus Van der Weijden","doi":"10.1111/prd.70022","DOIUrl":"https://doi.org/10.1111/prd.70022","url":null,"abstract":"Maintaining optimal oral hygiene is important for overall oral care, ensuring the well‐being of teeth and their surrounding tissues. In addition, it promotes fresh breath and a pleasing smile. A key element of oral self‐care is the daily use of toothpaste during regular brushing. This plays an important role in preventing tooth decay and addressing broader oral health concerns like periodontal diseases. Toothpaste ingredients offer significant benefits to oral health, particularly stannous fluoride, which contributes to the efficacy of toothpaste formulations by demonstrating notable anticariogenic and antibacterial properties. However, toothpaste has potential side effects, such as those caused by flavoring, and sodium lauryl sulfate, a foaming agent known for its potential to irritate mucous membranes. Beyond toothpaste, the integration of mouthwash into daily oral care routines offers the potential to further improve overall oral hygiene. Chlorhexidine in mouthwash formulations stands out as an active ingredient that is highly effective. This paper investigates the effects of chemical plaque inhibitors where possible through comprehensive systematic evaluations of existing literature. It aimed to provide an understanding of how chemical agents used in oral self‐care contribute to promoting and maintaining optimal oral hygiene.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"5 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145583116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Poliana Mendes Duarte, Rafael Lazarin, Nathalia Vilela, Magda Feres
Smoking and diabetes mellitus (DM) are major risk factors for periodontitis, often leading to greater disease severity and reduced response to scaling and root planing (SRP). Consequently, adjunctive therapies have been explored to enhance treatment outcomes in these high‐risk populations. Given that periodontitis is an infectious‐inflammatory disease, both antimicrobial and host‐modulating agents have been proposed as adjuncts to support mechanical debridement. This narrative review critically evaluates clinical evidence from randomized clinical trials and systematic reviews assessing the efficacy of these adjuncts in the nonsurgical management of periodontitis in smokers and patients with DM. Local antimicrobials have shown site‐specific clinical benefits like probing depth reduction and clinical attachment gain, particularly in deep pockets, although microbiological evidence is limited. Systemic antimicrobials, particularly the amoxicillin‐metronidazole combination, demonstrated sustained clinical and microbiological improvements, especially in diabetic patients. Among host‐modulating strategies, sub‐antimicrobial dose doxycycline and locally delivered statins have shown promising effects, though high‐quality, long‐term evidence is still lacking. Adjunctive therapies may improve periodontal treatment outcomes in high‐risk populations, particularly in cases of severe disease. Nonetheless, significant heterogeneity in study design, outcome assessment, and risk factor control limits the generalizability of current findings. Future research should prioritize rigorous methodology, stratified analyses, and the use of clinically meaningful endpoints to better inform evidence‐based decisions on adjunctive therapies in patients with risk factors.
{"title":"Adjunctive antimicrobials and host modulators in nonsurgical periodontal therapy: Focus on patients with diabetes and smokers","authors":"Poliana Mendes Duarte, Rafael Lazarin, Nathalia Vilela, Magda Feres","doi":"10.1111/prd.70020","DOIUrl":"https://doi.org/10.1111/prd.70020","url":null,"abstract":"Smoking and diabetes mellitus (DM) are major risk factors for periodontitis, often leading to greater disease severity and reduced response to scaling and root planing (SRP). Consequently, adjunctive therapies have been explored to enhance treatment outcomes in these high‐risk populations. Given that periodontitis is an infectious‐inflammatory disease, both antimicrobial and host‐modulating agents have been proposed as adjuncts to support mechanical debridement. This narrative review critically evaluates clinical evidence from randomized clinical trials and systematic reviews assessing the efficacy of these adjuncts in the nonsurgical management of periodontitis in smokers and patients with DM. Local antimicrobials have shown site‐specific clinical benefits like probing depth reduction and clinical attachment gain, particularly in deep pockets, although microbiological evidence is limited. Systemic antimicrobials, particularly the amoxicillin‐metronidazole combination, demonstrated sustained clinical and microbiological improvements, especially in diabetic patients. Among host‐modulating strategies, sub‐antimicrobial dose doxycycline and locally delivered statins have shown promising effects, though high‐quality, long‐term evidence is still lacking. Adjunctive therapies may improve periodontal treatment outcomes in high‐risk populations, particularly in cases of severe disease. Nonetheless, significant heterogeneity in study design, outcome assessment, and risk factor control limits the generalizability of current findings. Future research should prioritize rigorous methodology, stratified analyses, and the use of clinically meaningful endpoints to better inform evidence‐based decisions on adjunctive therapies in patients with risk factors.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"117 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pablo Galindo‐Moreno, Tiziano Testori, Miguel Padial‐Molina, Allinson Olaechea, Francisco O'Valle, Pablo Galindo‐Fernandez
Maxillary sinus augmentation shows a low incidence of complications and high clinical success due to favorable biological conditions and typically transient issues. Most complications are intraoperative, such as Schneiderian membrane perforation or hemorrhage, and are often resolved immediately. Postoperative complications, like sinusitis, graft loss, and voice alterations, are less frequent but clinically relevant. This study evaluates the long‐term effects of intraoperative and postoperative complications in maxillary sinus augmentation. A specific classification was used to differentiate these complications, focusing on their impact on bone graft maintenance and dental implant survival. Special attention was given to the progression of sinus inflammatory pathology, from preoperative conditions to acute and chronic sinusitis. While intraoperative complications are generally manageable, they can predispose patients to postoperative issues that affect long‐term outcomes. Sinus membrane perforation emerged as a key intraoperative factor linked to later sinusitis, compromising graft integrity and implant stability. The evolution of sinus inflammation significantly influences the long‐term success of both graft material and implants. Complications in maxillary sinus augmentation, if not properly managed, can have lasting effects. Careful surgical technique and thorough postoperative monitoring are essential to mitigate risks and ensure long‐term success. Recognizing the long‐term impact of these complications is crucial for optimizing outcomes in maxillary sinus augmentation.
{"title":"Long‐term stability of sinus complication management","authors":"Pablo Galindo‐Moreno, Tiziano Testori, Miguel Padial‐Molina, Allinson Olaechea, Francisco O'Valle, Pablo Galindo‐Fernandez","doi":"10.1111/prd.70021","DOIUrl":"https://doi.org/10.1111/prd.70021","url":null,"abstract":"Maxillary sinus augmentation shows a low incidence of complications and high clinical success due to favorable biological conditions and typically transient issues. Most complications are intraoperative, such as Schneiderian membrane perforation or hemorrhage, and are often resolved immediately. Postoperative complications, like sinusitis, graft loss, and voice alterations, are less frequent but clinically relevant. This study evaluates the long‐term effects of intraoperative and postoperative complications in maxillary sinus augmentation. A specific classification was used to differentiate these complications, focusing on their impact on bone graft maintenance and dental implant survival. Special attention was given to the progression of sinus inflammatory pathology, from preoperative conditions to acute and chronic sinusitis. While intraoperative complications are generally manageable, they can predispose patients to postoperative issues that affect long‐term outcomes. Sinus membrane perforation emerged as a key intraoperative factor linked to later sinusitis, compromising graft integrity and implant stability. The evolution of sinus inflammation significantly influences the long‐term success of both graft material and implants. Complications in maxillary sinus augmentation, if not properly managed, can have lasting effects. Careful surgical technique and thorough postoperative monitoring are essential to mitigate risks and ensure long‐term success. Recognizing the long‐term impact of these complications is crucial for optimizing outcomes in maxillary sinus augmentation.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"56 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145498366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Guided tissue regeneration (GTR) and guided bone regeneration (GBR) membranes are critical for reconstructing periodontal/bone defects, but existing membranes face limitations in osteogenic potential, antibacterial efficacy, degradation kinetics, mechanical stability, and immunomodulation within the complex oral microenvironment. This review aims to explore cellular interactions between alveolar bone regenerative cells and GBR/GTR membranes, membrane design strategies based on biological functions, and advancements in material engineering to overcome current clinical challenges. A comprehensive search strategy was implemented across PubMed, Scopus, Web of Science databases, as well as clinical trials registers. Data pertinent to membrane synthetic methodology, biological behavior, tissue regeneration outcomes were retrieved from the original studies. A qualitative assessment was performed. Overall, ideal GBR/GTR membranes must meet several functional requirements: (i) Clinical necessities include biocompatibility, selective permeability for nutrient exchange, and clinical operability. GTR aims to create and maintain a stable isolated space to protect blood clots, thereby enabling blood clots and the newly formed tissue to effectively block the migration of epithelial cells. GBR demands rigid space maintenance to resist mucosal compression in edentulous ridges, with greater emphasis on mechanical stability for large bone defects. Degradation kinetics must align with slower bone formation (3-6 months). (ii) Appropriate surface properties (roughness, morphology, stiffness, wettability, charge) and porosity/pore size are critical for cell behavior. (iii) Membrane-based biological regulation can promote cell adhesion and migration, and balance osteoclastogenesis and osteogenesis. Optimization strategies include incorporating bioactive substances for bone regeneration, immunomodulatory agents for anti-inflammatory responses, and antibacterial additives for clinical performance. GBR/GTR membranes require multifunctional integration of barrier functionality, tailored biodegradation, mechanical robustness, and proactive bioactivity (osteogenic, angiogenic, immunomodulatory, and antibacterial). Future designs must prioritize understanding cell-material interactions to develop membranes that dynamically synchronize with the regenerative microenvironment. This review provides a foundation for developing next-generation membranes that effectively address complex oral microenvironment challenges and significantly improve clinical outcomes in bone defect reconstruction. Optimized membranes will enhance space maintenance, reduce infection rates, mitigate premature degradation, and improve predictability in reconstructing periodontal and alveolar bone defects, ultimately advancing regenerative outcomes in implant dentistry and periodontal surgery.
引导组织再生膜（GTR）和引导骨再生膜（GBR）是重建牙周/骨缺损的关键，但现有膜在成骨潜能、抗菌功效、降解动力学、机械稳定性和复杂口腔微环境中的免疫调节方面存在局限性。本文旨在探讨牙槽骨再生细胞与GBR/GTR膜之间的细胞相互作用，基于生物功能的膜设计策略，以及材料工程的进展，以克服当前的临床挑战。在PubMed、Scopus、Web of Science数据库以及临床试验注册中实施了全面的搜索策略。有关膜合成方法、生物行为、组织再生结果的数据从原始研究中检索。进行了定性评估。总的来说，理想的GBR/GTR膜必须满足以下几个功能要求：(i)临床需要包括生物相容性、营养物质交换的选择性渗透性和临床可操作性。GTR旨在创造和维持一个稳定的隔离空间来保护血凝块，从而使血凝块和新形成的组织能够有效地阻断上皮细胞的迁移。GBR需要刚性空间维护以抵抗无牙嵴的粘膜压迫，对于大骨缺损更强调机械稳定性。降解动力学必须与较慢的骨形成（3-6个月）一致。（ii）适当的表面特性（粗糙度、形貌、刚度、润湿性、电荷）和孔隙率/孔径对细胞行为至关重要。（iii）基于膜的生物调控可以促进细胞粘附和迁移，平衡破骨和成骨。优化策略包括加入生物活性物质用于骨再生，免疫调节剂用于抗炎反应，抗菌添加剂用于临床性能。GBR/GTR膜需要屏障功能的多功能集成、定制的生物降解、机械稳健性和主动生物活性（成骨、血管生成、免疫调节和抗菌）。未来的设计必须优先理解细胞-物质相互作用，以开发与再生微环境动态同步的膜。这一综述为开发下一代膜提供了基础，这些膜可以有效地解决复杂的口腔微环境挑战，并显著改善骨缺损重建的临床结果。优化后的膜将加强空间维护，降低感染率，减轻过早降解，提高牙周和牙槽骨缺损重建的可预测性，最终提高种植牙科和牙周手术的再生效果。
{"title":"Functional requirements for guided bone regeneration/guided tissue regeneration membrane design: Progress and challenges.","authors":"Huilu Zhan,Ruijianghan Shi,Haohao Ni,Haiyan Li,Changyong Yuan,Kaili Lin,Anton Sculean,Richard J Miron","doi":"10.1111/prd.70019","DOIUrl":"https://doi.org/10.1111/prd.70019","url":null,"abstract":"Guided tissue regeneration (GTR) and guided bone regeneration (GBR) membranes are critical for reconstructing periodontal/bone defects, but existing membranes face limitations in osteogenic potential, antibacterial efficacy, degradation kinetics, mechanical stability, and immunomodulation within the complex oral microenvironment. This review aims to explore cellular interactions between alveolar bone regenerative cells and GBR/GTR membranes, membrane design strategies based on biological functions, and advancements in material engineering to overcome current clinical challenges. A comprehensive search strategy was implemented across PubMed, Scopus, Web of Science databases, as well as clinical trials registers. Data pertinent to membrane synthetic methodology, biological behavior, tissue regeneration outcomes were retrieved from the original studies. A qualitative assessment was performed. Overall, ideal GBR/GTR membranes must meet several functional requirements: (i) Clinical necessities include biocompatibility, selective permeability for nutrient exchange, and clinical operability. GTR aims to create and maintain a stable isolated space to protect blood clots, thereby enabling blood clots and the newly formed tissue to effectively block the migration of epithelial cells. GBR demands rigid space maintenance to resist mucosal compression in edentulous ridges, with greater emphasis on mechanical stability for large bone defects. Degradation kinetics must align with slower bone formation (3-6 months). (ii) Appropriate surface properties (roughness, morphology, stiffness, wettability, charge) and porosity/pore size are critical for cell behavior. (iii) Membrane-based biological regulation can promote cell adhesion and migration, and balance osteoclastogenesis and osteogenesis. Optimization strategies include incorporating bioactive substances for bone regeneration, immunomodulatory agents for anti-inflammatory responses, and antibacterial additives for clinical performance. GBR/GTR membranes require multifunctional integration of barrier functionality, tailored biodegradation, mechanical robustness, and proactive bioactivity (osteogenic, angiogenic, immunomodulatory, and antibacterial). Future designs must prioritize understanding cell-material interactions to develop membranes that dynamically synchronize with the regenerative microenvironment. This review provides a foundation for developing next-generation membranes that effectively address complex oral microenvironment challenges and significantly improve clinical outcomes in bone defect reconstruction. Optimized membranes will enhance space maintenance, reduce infection rates, mitigate premature degradation, and improve predictability in reconstructing periodontal and alveolar bone defects, ultimately advancing regenerative outcomes in implant dentistry and periodontal surgery.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"29 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145491577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Grade C molar-incisor pattern periodontitis (C-MIP) is characterized by an aggressive and rapid loss of tooth-supporting structures, affecting 1st molars incisors. This response seems to be due to an exaggerated host inflammatory response triggered by a dysbiotic and specific microbial environment. With higher prevalence in young individuals of lower socioeconomic status and African descendants, or from mixed-race populations, this disease also shows a strong familial aggregation that points to a genetic contribution, not yet fully elucidated. Despite the high focus on 1st molar and incisor permanent dentition with usual onset around puberty, this aggressive attachment bone loss has also been reported in the primary dentition, with some retrospective studies suggesting a possible disease initiation in the prepubertal stages. A. actinomycetemcomitans has been strongly implicated in C-MIP severity and progression, although newer technologies have pointed out some other associated species implicated in this disease. Although several clinical therapies have been proposed to treat C-MIP over time, nonsurgical mechanical treatment with systemic antibiotics (ABX) has shown a positive impact on clinical, immunological, and microbiological outcomes in the short and long term, both in primary and permanent affected dentitions. Despite the limited comparative clinical trials approaching C-MIP, the combination of adjunctive amoxicillin (AMX) and metronidazole (MTZ) with nonsurgical debridement is the most recommended ABX regimen to date. Several bacterial species associated with C-MIP are also reduced following this regimen, along with an increased number of health-associated species and modulation of the inflammatory response, both locally and systemically, associated with clinical parameters of success. Despite the systemic ABX benefits, the authors emphasize the importance of early diagnosis and patients' compliance with frequent maintenance care to sustain successful outcomes. Surgical intervention may also be recommended based on remaining residual pockets, along with residual intrabony defects and furcation involvement. In this review, the authors also highlight a comparison of treatment approaches with generalized forms of the disease in young individuals (C-G) and discuss potential future strategies to understand better, prevent, and successfully treat this aggressive disease.
{"title":"Antibiotics in the treatment of young patients with molar-incisor pattern periodontitis (C-MIP).","authors":"Manuela Maria Viana Miguel,Mauro Pedrine Santamaria,Renato Corrêa Viana Casarin,Camila Schmidt Stolf,Luciana Salles Branco-de-Almeida,Luciana Macchion Shaddox","doi":"10.1111/prd.70004","DOIUrl":"https://doi.org/10.1111/prd.70004","url":null,"abstract":"Grade C molar-incisor pattern periodontitis (C-MIP) is characterized by an aggressive and rapid loss of tooth-supporting structures, affecting 1st molars incisors. This response seems to be due to an exaggerated host inflammatory response triggered by a dysbiotic and specific microbial environment. With higher prevalence in young individuals of lower socioeconomic status and African descendants, or from mixed-race populations, this disease also shows a strong familial aggregation that points to a genetic contribution, not yet fully elucidated. Despite the high focus on 1st molar and incisor permanent dentition with usual onset around puberty, this aggressive attachment bone loss has also been reported in the primary dentition, with some retrospective studies suggesting a possible disease initiation in the prepubertal stages. A. actinomycetemcomitans has been strongly implicated in C-MIP severity and progression, although newer technologies have pointed out some other associated species implicated in this disease. Although several clinical therapies have been proposed to treat C-MIP over time, nonsurgical mechanical treatment with systemic antibiotics (ABX) has shown a positive impact on clinical, immunological, and microbiological outcomes in the short and long term, both in primary and permanent affected dentitions. Despite the limited comparative clinical trials approaching C-MIP, the combination of adjunctive amoxicillin (AMX) and metronidazole (MTZ) with nonsurgical debridement is the most recommended ABX regimen to date. Several bacterial species associated with C-MIP are also reduced following this regimen, along with an increased number of health-associated species and modulation of the inflammatory response, both locally and systemically, associated with clinical parameters of success. Despite the systemic ABX benefits, the authors emphasize the importance of early diagnosis and patients' compliance with frequent maintenance care to sustain successful outcomes. Surgical intervention may also be recommended based on remaining residual pockets, along with residual intrabony defects and furcation involvement. In this review, the authors also highlight a comparison of treatment approaches with generalized forms of the disease in young individuals (C-G) and discuss potential future strategies to understand better, prevent, and successfully treat this aggressive disease.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"13 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Richard J. Miron, Nathan E. Estrin, Ana Paz, Reinhard Gruber, Nima Farshidfar, Yufeng Zhang, Anton Sculean, Thomas G. Wiedemann, Paras Ahmad
Background This systematic review investigated the relationship between pre‐operative vitamin D levels and implant osseointegration and implant‐related outcomes. It also assessed studies involving vitamin D supplementation before implant placement. Methods In vivo experimental and clinical studies published up to May 15, 2025, were reviewed. Out of 151 initially identified publications, 43 met the inclusion criteria. Results In total, 16 animal and 27 human studies were included. Most animal studies investigated vitamin D supplementation before implant placement (nine studies), whereas six studies explored vitamin D coatings on implant surfaces. Animal models included osteoporosis, diabetes mellitus, ultraviolet (UV) light deficiency, chronic kidney disease‐induced uremia, and orchiectomy. A positive effect was found for vitamin D on implant osseointegration in 13 of the 16 studies. The human studies comprised three case reports, 10 retrospective studies, three prospective case series, eight prospective controlled trials (2–4 cohorts), and three randomized clinical trials (RCTs). Collectively, 22 of the 27 human studies supported a beneficial association between adequate vitamin D levels and improved implant osseointegration or reduced early implant failure. Vitamin D deficiency was associated with up to a fourfold increase in early implant failures. Pre‐surgical supplementation with vitamin D 3 enhanced implant osseointegration, improved bone‐implant‐contact (BIC), promoted peri‐implant bone preservation, and reduced early implant failures, even among high‐risk populations (i.e., diabetics). When implant‐related parameters such as pocket depths, radiographic marginal bone levels, or implant stability were measured, significantly poorer outcomes were consistently observed in vitamin D‐deficient groups. Conclusions/Clinical Relevance Evidence from both animal and human studies strongly indicates that vitamin D deficiency impairs both new bone formation and BIC. Supplementation, particularly in patients with systemic conditions, may improve implant osseointegration outcomes. Pre‐operative screening and correction of vitamin D deficiency are recommended to optimize implant success. Additional well‐designed prospective clinical trials and RCTs are needed to further elucidate the extent of the correlation between serum vitamin D deficiency and the risk of implant failure.
{"title":"Relationship between vitamin D deficiency and early implant failure and osseointegration","authors":"Richard J. Miron, Nathan E. Estrin, Ana Paz, Reinhard Gruber, Nima Farshidfar, Yufeng Zhang, Anton Sculean, Thomas G. Wiedemann, Paras Ahmad","doi":"10.1111/prd.70017","DOIUrl":"https://doi.org/10.1111/prd.70017","url":null,"abstract":"Background This systematic review investigated the relationship between pre‐operative vitamin D levels and implant osseointegration and implant‐related outcomes. It also assessed studies involving vitamin D supplementation before implant placement. Methods <jats:italic>In vivo</jats:italic> experimental and clinical studies published up to May 15, 2025, were reviewed. Out of 151 initially identified publications, 43 met the inclusion criteria. Results In total, 16 animal and 27 human studies were included. Most animal studies investigated vitamin D supplementation before implant placement (nine studies), whereas six studies explored vitamin D coatings on implant surfaces. Animal models included osteoporosis, diabetes mellitus, ultraviolet (UV) light deficiency, chronic kidney disease‐induced uremia, and orchiectomy. A positive effect was found for vitamin D on implant osseointegration in 13 of the 16 studies. The human studies comprised three case reports, 10 retrospective studies, three prospective case series, eight prospective controlled trials (2–4 cohorts), and three randomized clinical trials (RCTs). Collectively, 22 of the 27 human studies supported a beneficial association between adequate vitamin D levels and improved implant osseointegration or reduced early implant failure. Vitamin D deficiency was associated with up to a fourfold increase in early implant failures. Pre‐surgical supplementation with vitamin D <jats:sub>3</jats:sub> enhanced implant osseointegration, improved bone‐implant‐contact (BIC), promoted peri‐implant bone preservation, and reduced early implant failures, even among high‐risk populations (i.e., diabetics). When implant‐related parameters such as pocket depths, radiographic marginal bone levels, or implant stability were measured, significantly poorer outcomes were consistently observed in vitamin D‐deficient groups. Conclusions/Clinical Relevance Evidence from both animal and human studies strongly indicates that vitamin D deficiency impairs both new bone formation and BIC. Supplementation, particularly in patients with systemic conditions, may improve implant osseointegration outcomes. Pre‐operative screening and correction of vitamin D deficiency are recommended to optimize implant success. Additional well‐designed prospective clinical trials and RCTs are needed to further elucidate the extent of the correlation between serum vitamin D deficiency and the risk of implant failure.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"10 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145396911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lorenzo Tavelli,Shayan Barootchi,Samuel Akhondi,Edward Shih-Chang Tseng,Francisco Salvador Garcia-Valenzuela,Istvan A Urban,Hom-Lay Wang
BACKGROUNDPeri-implant soft tissue phenotype plays a pivotal role in the long-term success of dental implants, influencing health, esthetic, and patient-reported outcomes. This review explores the long-term stability of soft tissue augmentation procedures at implant sites, focusing on keratinized mucosa (KM), mucosal thickness (MT), and supracrestal tissue height (STH), and investigating predictors for the stability of the soft tissue margin over time.MATERIALS AND METHODSA narrative review aiming at identifying clinical studies reporting on the long-term outcomes of soft tissue augmentation procedures at implant sites was conducted.RESULTSRobust evidence demonstrates that an inadequate soft tissue phenotype, particularly limited KM and thin MT, is associated with increased inflammation, soft tissue dehiscence, and marginal bone loss. Clinical trials and longitudinal studies show that augmentative procedures, including autogenous free gingival grafts, connective tissue grafts, and soft tissue substitutes, lead to stable outcomes in terms of soft tissue levels, volume, and esthetics. Techniques targeting MT and STH, especially through bilaminar approaches, further enhance long-term peri-implant tissue stability. Additionally, soft tissue augmentation has proven effective for managing peri-implant soft tissue dehiscences and improving papilla height, with the stability of the outcomes reported for up to 10 years.CONCLUSIONSThis review highlights the synergistic role of KM, MT, and STH in supporting peri-implant health, esthetics, and long-term tissue stability, and underscores the need for personalized treatment planning based on peri-implant phenotype. Clinical recommendations for when and how to intervene are provided based on the best available evidence.CLINICAL RELEVANCELong-term data support the importance of soft tissue augmentation in ensuring implant success, particularly in esthetically demanding zones and compromised sites.
{"title":"Long-term stability of soft tissue augmentative procedures at implant sites.","authors":"Lorenzo Tavelli,Shayan Barootchi,Samuel Akhondi,Edward Shih-Chang Tseng,Francisco Salvador Garcia-Valenzuela,Istvan A Urban,Hom-Lay Wang","doi":"10.1111/prd.70016","DOIUrl":"https://doi.org/10.1111/prd.70016","url":null,"abstract":"BACKGROUNDPeri-implant soft tissue phenotype plays a pivotal role in the long-term success of dental implants, influencing health, esthetic, and patient-reported outcomes. This review explores the long-term stability of soft tissue augmentation procedures at implant sites, focusing on keratinized mucosa (KM), mucosal thickness (MT), and supracrestal tissue height (STH), and investigating predictors for the stability of the soft tissue margin over time.MATERIALS AND METHODSA narrative review aiming at identifying clinical studies reporting on the long-term outcomes of soft tissue augmentation procedures at implant sites was conducted.RESULTSRobust evidence demonstrates that an inadequate soft tissue phenotype, particularly limited KM and thin MT, is associated with increased inflammation, soft tissue dehiscence, and marginal bone loss. Clinical trials and longitudinal studies show that augmentative procedures, including autogenous free gingival grafts, connective tissue grafts, and soft tissue substitutes, lead to stable outcomes in terms of soft tissue levels, volume, and esthetics. Techniques targeting MT and STH, especially through bilaminar approaches, further enhance long-term peri-implant tissue stability. Additionally, soft tissue augmentation has proven effective for managing peri-implant soft tissue dehiscences and improving papilla height, with the stability of the outcomes reported for up to 10 years.CONCLUSIONSThis review highlights the synergistic role of KM, MT, and STH in supporting peri-implant health, esthetics, and long-term tissue stability, and underscores the need for personalized treatment planning based on peri-implant phenotype. Clinical recommendations for when and how to intervene are provided based on the best available evidence.CLINICAL RELEVANCELong-term data support the importance of soft tissue augmentation in ensuring implant success, particularly in esthetically demanding zones and compromised sites.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"53 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145373635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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