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}
BACKGROUNDCurrent periodontal treatment strategies are primarily informed by population-level data, emphasizing average patient outcomes. Adjunctive antibiotic use-typically amoxicillin combined with metronidazole-is guided by clinical markers of disease severity and progression risk. However, such broad-spectrum regimens may disrupt the oral and gut microbiota, contributing to antimicrobial resistance.AIMThis chapter evaluates the rationale for empirical versus individualized use of antimicrobial agents in periodontal therapy.MATERIALS AND METHODSA critical review of existing literature was conducted to assess the clinical efficacy and risks of empirical protocols and to explore the potential of personalized antimicrobial strategies.RESULTSEvidence from clinical trials does not consistently support superior outcomes with microbiologically or biologically guided antimicrobial therapy. The cost-effectiveness and patient benefit of such testing remain unclear. Nonetheless, variability in pathogenic profiles, microbiome dynamics, individual host responses, and pharmacological factors supports a move toward personalized therapeutic approaches. Advances in personalized medicine-utilizing genetic testing, biomarkers, and machine learning-enable integration of genomic, proteomic, and metabolomic data to inform targeted interventions, potentially improving efficacy and minimizing adverse effects.CLINICAL RELEVANCEThe future of periodontal therapy is likely to integrate population-based evidence with individualized treatment planning. This hybrid model aims to enhance clinical outcomes by combining broad evidence-based guidelines with patient-specific data, reflecting a shift toward precision medicine in clinical practice.
{"title":"Empiric or individually targeted antimicrobial therapy. Historical perspective and current state.","authors":"Andrea Mombelli,Lindsey Edwards,Luigi Nibali","doi":"10.1111/prd.70008","DOIUrl":"https://doi.org/10.1111/prd.70008","url":null,"abstract":"BACKGROUNDCurrent periodontal treatment strategies are primarily informed by population-level data, emphasizing average patient outcomes. Adjunctive antibiotic use-typically amoxicillin combined with metronidazole-is guided by clinical markers of disease severity and progression risk. However, such broad-spectrum regimens may disrupt the oral and gut microbiota, contributing to antimicrobial resistance.AIMThis chapter evaluates the rationale for empirical versus individualized use of antimicrobial agents in periodontal therapy.MATERIALS AND METHODSA critical review of existing literature was conducted to assess the clinical efficacy and risks of empirical protocols and to explore the potential of personalized antimicrobial strategies.RESULTSEvidence from clinical trials does not consistently support superior outcomes with microbiologically or biologically guided antimicrobial therapy. The cost-effectiveness and patient benefit of such testing remain unclear. Nonetheless, variability in pathogenic profiles, microbiome dynamics, individual host responses, and pharmacological factors supports a move toward personalized therapeutic approaches. Advances in personalized medicine-utilizing genetic testing, biomarkers, and machine learning-enable integration of genomic, proteomic, and metabolomic data to inform targeted interventions, potentially improving efficacy and minimizing adverse effects.CLINICAL RELEVANCEThe future of periodontal therapy is likely to integrate population-based evidence with individualized treatment planning. This hybrid model aims to enhance clinical outcomes by combining broad evidence-based guidelines with patient-specific data, reflecting a shift toward precision medicine in clinical practice.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"71 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338803","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}
Paul I Eke,Liang Wei,Gina Thornton-Evans,Kurt Greenlund,Wenche S Borgnakke
This study explored the associations between tooth loss and all-cause mortality among 8710 community-dwelling US adults aged ≥30 years who participated in the National Health and Nutrition Examination Surveys (NHANES) III in 1988-1994 and subsequently were linked to the 2006 National Center for Health Statistics (NCHS) public-use mortality records. At baseline, 22.3% had all 28 non-third molar teeth, 36.4% were missing 1-5 teeth, 28.0% 6-27 teeth, and 13.3 % all 28 teeth. During 12-18 (mean = 14.2) years, 2,385 participants died with 22.4% of the deceased being edentulous versus 12.7% having 28 teeth. Age-adjusted mortality rate was 29.3 (±0.6)/1000 person-years among the former versus 9.9 (±1.3) among the latter. Age-adjusted mortality was associated with edentulism, with edentate being 2.6 times (HR = 2.58; 95% CI: 1.81-3.69) more likely to have died than fully dentate, though attenuated upon further adjustment to 45% greater risk (HR = 1.45; 95% CI: 1.02-2.05). In contrast, this association between mortality and missing some, but not all teeth, was non-significant upon adjustment for all covariates. In conclusion, edentulism-but not missing <28 teeth-among US adults aged >30 years was statistically significantly associated with all-cause mortality over an average of 14.2 years later.
{"title":"Missing teeth and all-cause mortality in US adults.","authors":"Paul I Eke,Liang Wei,Gina Thornton-Evans,Kurt Greenlund,Wenche S Borgnakke","doi":"10.1111/prd.12640","DOIUrl":"https://doi.org/10.1111/prd.12640","url":null,"abstract":"This study explored the associations between tooth loss and all-cause mortality among 8710 community-dwelling US adults aged ≥30 years who participated in the National Health and Nutrition Examination Surveys (NHANES) III in 1988-1994 and subsequently were linked to the 2006 National Center for Health Statistics (NCHS) public-use mortality records. At baseline, 22.3% had all 28 non-third molar teeth, 36.4% were missing 1-5 teeth, 28.0% 6-27 teeth, and 13.3 % all 28 teeth. During 12-18 (mean = 14.2) years, 2,385 participants died with 22.4% of the deceased being edentulous versus 12.7% having 28 teeth. Age-adjusted mortality rate was 29.3 (±0.6)/1000 person-years among the former versus 9.9 (±1.3) among the latter. Age-adjusted mortality was associated with edentulism, with edentate being 2.6 times (HR = 2.58; 95% CI: 1.81-3.69) more likely to have died than fully dentate, though attenuated upon further adjustment to 45% greater risk (HR = 1.45; 95% CI: 1.02-2.05). In contrast, this association between mortality and missing some, but not all teeth, was non-significant upon adjustment for all covariates. In conclusion, edentulism-but not missing <28 teeth-among US adults aged >30 years was statistically significantly associated with all-cause mortality over an average of 14.2 years later.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"108 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145339023","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}
Bob T Rosier,George Hajishengallis,David A Wink,Alex Mira
BACKGROUNDDietary nitrate, primarily sourced from vegetables, is reduced by oral bacteria to nitrite and subsequently to nitric oxide (NO), a molecule with antimicrobial and immunoregulatory properties, as well as vasodilatory and other cardiometabolic effects. Studies have shown that nitrate supplementation can lower blood pressure, reduce gingival inflammation, and lead to a shift toward microbial eubiosis in the periodontium. However, a paradox arises: nitrate and nitrite-when produced via NO synthase (NOS) activity during chronic inflammation-can serve as biomarkers of periodontitis.AIMThis narrative review aims to (1) examine the molecular mechanisms underlying the health benefits of NO, particularly those stimulated by nitrate-rich vegetable intake; and (2) explore how chronic inflammation can alter the local environment leading to nitrate and nitrite accumulation.MATERIALS AND METHODSA targeted literature search was conducted in PubMed and Google Scholar to identify articles related to NO, nitrate metabolism, inflammation, and/or periodontitis.RESULTSUnder homeostatic conditions, NO can react with bacterial iron-sulfur clusters, promoting the elimination of sensitive species, and with host soluble guanylyl cyclase (sGC), activating cGMP signaling pathways that suppress inflammation. In contrast, the inflammatory milieu of periodontitis is characterized by elevated levels of reactive oxygen species (ROS) and free heme, both of which act as NO scavengers, thereby diminishing its bioavailability. Importantly, the reaction of NO with ROS generates various reactive nitrogen species (RNS), which differ functionally from NO. These RNS can be converted into nitrate and/or nitrite (e.g., peroxynitrite, ONOO-, decomposes into nitrate), contributing to their accumulation. Additionally, oxidative stress promotes NOS uncoupling, converting NOS from a NO-producing to a ROS-producing enzyme. Furthermore, periodontitis is associated with an impaired nitrate-reduction capacity of the oral microbiota, further decreasing NO levels.CLINICAL RELEVANCEOxidative stress and reduced NO availability may drive periodontal dysbiosis and contribute to the systemic impact of periodontitis. These disease-related conditions could be mitigated through dietary interventions with nitrate-rich vegetables and adjunctive use of nitrate-reducing probiotics, which warrants further investigation.
{"title":"Nitrate metabolism and periodontal health: The roles of nitric oxide in microbial killing and immunoregulation.","authors":"Bob T Rosier,George Hajishengallis,David A Wink,Alex Mira","doi":"10.1111/prd.70006","DOIUrl":"https://doi.org/10.1111/prd.70006","url":null,"abstract":"BACKGROUNDDietary nitrate, primarily sourced from vegetables, is reduced by oral bacteria to nitrite and subsequently to nitric oxide (NO), a molecule with antimicrobial and immunoregulatory properties, as well as vasodilatory and other cardiometabolic effects. Studies have shown that nitrate supplementation can lower blood pressure, reduce gingival inflammation, and lead to a shift toward microbial eubiosis in the periodontium. However, a paradox arises: nitrate and nitrite-when produced via NO synthase (NOS) activity during chronic inflammation-can serve as biomarkers of periodontitis.AIMThis narrative review aims to (1) examine the molecular mechanisms underlying the health benefits of NO, particularly those stimulated by nitrate-rich vegetable intake; and (2) explore how chronic inflammation can alter the local environment leading to nitrate and nitrite accumulation.MATERIALS AND METHODSA targeted literature search was conducted in PubMed and Google Scholar to identify articles related to NO, nitrate metabolism, inflammation, and/or periodontitis.RESULTSUnder homeostatic conditions, NO can react with bacterial iron-sulfur clusters, promoting the elimination of sensitive species, and with host soluble guanylyl cyclase (sGC), activating cGMP signaling pathways that suppress inflammation. In contrast, the inflammatory milieu of periodontitis is characterized by elevated levels of reactive oxygen species (ROS) and free heme, both of which act as NO scavengers, thereby diminishing its bioavailability. Importantly, the reaction of NO with ROS generates various reactive nitrogen species (RNS), which differ functionally from NO. These RNS can be converted into nitrate and/or nitrite (e.g., peroxynitrite, ONOO-, decomposes into nitrate), contributing to their accumulation. Additionally, oxidative stress promotes NOS uncoupling, converting NOS from a NO-producing to a ROS-producing enzyme. Furthermore, periodontitis is associated with an impaired nitrate-reduction capacity of the oral microbiota, further decreasing NO levels.CLINICAL RELEVANCEOxidative stress and reduced NO availability may drive periodontal dysbiosis and contribute to the systemic impact of periodontitis. These disease-related conditions could be mitigated through dietary interventions with nitrate-rich vegetables and adjunctive use of nitrate-reducing probiotics, which warrants further investigation.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"17 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145305708","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}
BACKGROUNDAntibiotics marked a pivotal turning point in human civilization, enhancing social interactions and extending human life expectancy. In addition to their success in treating systemic infectious diseases, they have significantly improved periodontal treatment outcomes as an adjunct therapy. The current status of systemic antibiotics in periodontal therapy is well established. However, antibiotic-resistant bacteria emerged as a result of their overuse and misuse. It is estimated that by 2050, infections caused by multidrug-resistant bacteria could result in the deaths of 10 million people annually. Beyond promoting the expansion of resistant species, broad-spectrum antimicrobials also eliminate commensal microorganisms and disrupt the microbial balance in distant organs, both of which are essential for maintaining overall health.AIMThis narrative review acknowledges how the use of systemic antibiotics has contributed to our understanding of the role of microbial factors as therapeutic targets, presents novel and emerging technologies that will advance the field, and highlights emerging strategies aimed at eliminating oral disease-related microbial species without inducing antimicrobial resistance or causing dysbiosis in distant parts of the body.MATERIALS AND METHODSA literature search of the National Library of Medicine (MEDLINE/PubMed) database was conducted to identify publications related to new and developing antimicrobial approaches for treating oral infections without triggering antibiotic resistance or creating dysbiosis in other parts of the body.RESULTSPrevious studies suggest that targeted antimicrobials directed against oral pathobionts and locally effective antibiotics applied at disease sites are potential strategies to reduce the large-scale emergence of antimicrobial resistance and minimize microbiota disruption. Selective action is fundamental to the development of a targeted antimicrobial strategy: An ideal antimicrobial treatment should be highly specific to pathogenic microorganisms without harming the host or its commensal microbiota. In addition to targeted antibiotics and localized drug delivery systems, probiotics, antibodies, phage therapy, photodynamic therapy, and vaccination are promising approaches for addressing the issues associated with broad-spectrum antibiotics.FUTURE DIRECTIONSThe WHO has recommended a global action plan that calls for the development of novel antimicrobials or innovative therapeutic approaches for infectious diseases. New methods are required, extensive education programs should be offered worldwide, and stricter criteria for dental antibiotics should be developed using a comprehensive approach.
{"title":"Novel and emerging antimicrobial strategies in the management of oral infections.","authors":"Ozge Unlu,Nil Yakar,Alpdogan Kantarci","doi":"10.1111/prd.70015","DOIUrl":"https://doi.org/10.1111/prd.70015","url":null,"abstract":"BACKGROUNDAntibiotics marked a pivotal turning point in human civilization, enhancing social interactions and extending human life expectancy. In addition to their success in treating systemic infectious diseases, they have significantly improved periodontal treatment outcomes as an adjunct therapy. The current status of systemic antibiotics in periodontal therapy is well established. However, antibiotic-resistant bacteria emerged as a result of their overuse and misuse. It is estimated that by 2050, infections caused by multidrug-resistant bacteria could result in the deaths of 10 million people annually. Beyond promoting the expansion of resistant species, broad-spectrum antimicrobials also eliminate commensal microorganisms and disrupt the microbial balance in distant organs, both of which are essential for maintaining overall health.AIMThis narrative review acknowledges how the use of systemic antibiotics has contributed to our understanding of the role of microbial factors as therapeutic targets, presents novel and emerging technologies that will advance the field, and highlights emerging strategies aimed at eliminating oral disease-related microbial species without inducing antimicrobial resistance or causing dysbiosis in distant parts of the body.MATERIALS AND METHODSA literature search of the National Library of Medicine (MEDLINE/PubMed) database was conducted to identify publications related to new and developing antimicrobial approaches for treating oral infections without triggering antibiotic resistance or creating dysbiosis in other parts of the body.RESULTSPrevious studies suggest that targeted antimicrobials directed against oral pathobionts and locally effective antibiotics applied at disease sites are potential strategies to reduce the large-scale emergence of antimicrobial resistance and minimize microbiota disruption. Selective action is fundamental to the development of a targeted antimicrobial strategy: An ideal antimicrobial treatment should be highly specific to pathogenic microorganisms without harming the host or its commensal microbiota. In addition to targeted antibiotics and localized drug delivery systems, probiotics, antibodies, phage therapy, photodynamic therapy, and vaccination are promising approaches for addressing the issues associated with broad-spectrum antibiotics.FUTURE DIRECTIONSThe WHO has recommended a global action plan that calls for the development of novel antimicrobials or innovative therapeutic approaches for infectious diseases. New methods are required, extensive education programs should be offered worldwide, and stricter criteria for dental antibiotics should be developed using a comprehensive approach.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"28 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145288465","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}
Nathan E. Estrin, Troy B. Tran, Paras Ahmad, Nima Farshidfar, Georgios E. Romanos, Anton Sculean, Richard J. Miron
BackgroundPlatelet‐rich fibrin (PRF), a second‐generation autologous platelet concentrate, has gained significant interest for its anti‐inflammatory and regenerative characteristics. While its role in tissue healing is well‐recognized, the analgesic potential of PRF remains under‐investigated.AimThe primary objective of this systematic review was to critically evaluate any pain‐reported outcome of PRF across all medical and dental procedures in human studies. The secondary objective was to also evaluate outcomes regarding swelling reduction with PRF and other patient‐reported outcomes such as quality of life and analgesic consumption in all included studies.MethodsA systematic search of PubMed, Scopus, Web of Science, and Google Scholar databases was performed for comparative clinical studies assessing PRF's influence on postoperative pain. Eligible studies included human clinical trials comparing PRF with non‐PRF controls, with pain‐reported outcomes as the primary outcome. Data on swelling and other patient‐reported outcomes, including analgesic use and quality of life, was also evaluated as a secondary objective; however, studies that evaluated these outcomes alone were excluded. A total of 200 comparative clinical studies were included, covering a diverse range of procedures including third molar extractions, palatal wound healing, mucogingival procedures, periodontal/bone procedures, maxillary sinus lifts, endodontic procedures, orthodontic procedures, oral lesions, alveolar osteitis, oroantral communications, medically induced osteonecrosis of the jaw, temporomandibular joint disorders, orthopedic procedures, facial surgery and aesthetics, and other fields of medicine. However, heterogeneity in PRF preparation methods and outcome measures precluded a meta‐analysis.ResultsAlmost all studies reported reduced pain levels in the PRF group compared with non‐PRF controls, with additional benefits observed in terms of swelling reduction, decreased analgesic use, and improved patient‐reported outcomes. Importantly, it was observed that procedures that tend to generate the most patient‐reported pain, such as 3rd molar extractions and autogenous soft tissue grafting from the hard palate, generally reported much lower pain scores following PRF use (72%–85% of studies) and significantly reduced postoperative analgesic use (87.5% of studies).ConclusionsThe autologous nature of PRF, along with the sustained release of bioactive factors, likely plays a vital role in modulating inflammation and promoting tissue healing, hence enhancing patient comfort and recovery. As PRF continues to gain traction in clinical practice, integrating well‐designed comparative studies with standardized outcome measures will be necessary to completely understand its therapeutic potential and inform evidence‐based guidelines regarding its application.
富血小板纤维蛋白（PRF）是第二代自体血小板浓缩物，因其抗炎和再生特性而受到广泛关注。虽然PRF在组织愈合中的作用已得到广泛认可，但其镇痛潜力仍有待进一步研究。本系统综述的主要目的是在人类研究的所有医学和牙科手术中，批判性地评估PRF的任何疼痛报告结果。次要目的还包括评估所有纳入研究中PRF治疗消肿的结果和其他患者报告的结果，如生活质量和镇痛药的使用。方法系统检索PubMed、Scopus、Web of Science、b谷歌Scholar等数据库，进行比较临床研究，评估PRF对术后疼痛的影响。符合条件的研究包括比较PRF与非PRF对照的人类临床试验，以疼痛报告结果为主要结果。肿胀数据和其他患者报告的结果，包括镇痛药的使用和生活质量，也作为次要目标进行评估；然而，单独评估这些结果的研究被排除在外。总共包括200个比较临床研究，涵盖了各种各样的手术，包括第三磨牙拔牙、腭伤口愈合、粘膜牙龈手术、牙周/骨手术、上颌窦提升术、牙髓治疗、正畸治疗、口腔病变、牙槽骨炎、口腔-上颌沟通、医学引起的颌骨骨坏死、颞下颌关节疾病、骨科手术、面部外科和美学。以及其他医学领域。然而，PRF制备方法和结果测量的异质性妨碍了meta分析。结果：与非PRF对照组相比，几乎所有的研究都报告了PRF组疼痛水平的降低，在肿胀减轻、镇痛药使用减少和患者报告结果改善方面观察到额外的益处。重要的是，我们观察到，往往会产生最多患者报告的疼痛的手术，如第三磨牙拔牙和硬腭自体软组织移植，通常在使用PRF后报告的疼痛评分要低得多（72%-85%的研究），并显着减少术后止痛药的使用（87.5%的研究）。结论PRF的自体特性及其生物活性因子的持续释放可能在调节炎症和促进组织愈合方面发挥重要作用，从而提高患者的舒适度和恢复能力。随着PRF在临床实践中的应用越来越广泛，有必要将精心设计的比较研究与标准化的结果测量相结合，以完全了解其治疗潜力，并为其应用提供基于证据的指南。
{"title":"Analgesic effects of platelet‐rich fibrin (PRF): A systematic review","authors":"Nathan E. Estrin, Troy B. Tran, Paras Ahmad, Nima Farshidfar, Georgios E. Romanos, Anton Sculean, Richard J. Miron","doi":"10.1111/prd.70014","DOIUrl":"https://doi.org/10.1111/prd.70014","url":null,"abstract":"BackgroundPlatelet‐rich fibrin (PRF), a second‐generation autologous platelet concentrate, has gained significant interest for its anti‐inflammatory and regenerative characteristics. While its role in tissue healing is well‐recognized, the analgesic potential of PRF remains under‐investigated.AimThe primary objective of this systematic review was to critically evaluate any pain‐reported outcome of PRF across all medical and dental procedures in human studies. The secondary objective was to also evaluate outcomes regarding swelling reduction with PRF and other patient‐reported outcomes such as quality of life and analgesic consumption in all included studies.MethodsA systematic search of PubMed, Scopus, Web of Science, and Google Scholar databases was performed for comparative clinical studies assessing PRF's influence on postoperative pain. Eligible studies included human clinical trials comparing PRF with non‐PRF controls, with pain‐reported outcomes as the primary outcome. Data on swelling and other patient‐reported outcomes, including analgesic use and quality of life, was also evaluated as a secondary objective; however, studies that evaluated these outcomes alone were excluded. A total of 200 comparative clinical studies were included, covering a diverse range of procedures including third molar extractions, palatal wound healing, mucogingival procedures, periodontal/bone procedures, maxillary sinus lifts, endodontic procedures, orthodontic procedures, oral lesions, alveolar osteitis, oroantral communications, medically induced osteonecrosis of the jaw, temporomandibular joint disorders, orthopedic procedures, facial surgery and aesthetics, and other fields of medicine. However, heterogeneity in PRF preparation methods and outcome measures precluded a meta‐analysis.ResultsAlmost all studies reported reduced pain levels in the PRF group compared with non‐PRF controls, with additional benefits observed in terms of swelling reduction, decreased analgesic use, and improved patient‐reported outcomes. Importantly, it was observed that procedures that tend to generate the most patient‐reported pain, such as 3rd molar extractions and autogenous soft tissue grafting from the hard palate, generally reported much lower pain scores following PRF use (72%–85% of studies) and significantly reduced postoperative analgesic use (87.5% of studies).ConclusionsThe autologous nature of PRF, along with the sustained release of bioactive factors, likely plays a vital role in modulating inflammation and promoting tissue healing, hence enhancing patient comfort and recovery. As PRF continues to gain traction in clinical practice, integrating well‐designed comparative studies with standardized outcome measures will be necessary to completely understand its therapeutic potential and inform evidence‐based guidelines regarding its application.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"25 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282717","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}
OBJECTIVESThis systematic review investigated the efficacy of biologic factors in the surgical treatment of periodontal suprabony defects.MATERIALS AND METHODSThree databases were searched to identify RCTs comparing open-flap debridement (OFD) combined with biologic factors only, or combined with bone substitute, and/or barriers to the same intervention without biologics or OFD in terms of probing pocket depth (PPD) reduction, clinical attachment level (CAL) gain, and number of pockets closed. Risk of bias was performed according to RoB 2. Pairwise meta-analyses and frequentist network meta-analyses by using random-effects models were performed. GRADE was employed to assess the certainty of evidence.RESULTSTen studies reporting on 253 subjects were included. Overall, adding biologics to OFD leads to a significant improvement in post-treatment PPD and CAL at 9-12 months, with enamel matrix derivative (EMD) having the highest probability of being the best biologic for changes in PPD (-1.91 mm, 95% CI: -3.02, -0.81) and CAL (-2.24 mm, 95% CI: -2.68, -1.79) at a low level of evidence.CONCLUSIONThe addition of biologics provides an adjunctive benefit in post-treatment PPD and CAL. However, data should be interpreted with caution due to the heterogeneity of studies, limited data available, risk of bias, and low/moderate evidence.
目的探讨生物因素在牙周颌骨上缺损外科治疗中的作用。材料和方法检索三个数据库，以确定比较开放皮瓣清创（OFD）仅联合生物因素，或联合骨替代物，和/或在不使用生物制剂或OFD的情况下进行相同干预的rct，在探查袋深度（PPD）减少、临床附着水平（CAL）增加和关闭袋数量方面。偏倚风险按照RoB 2进行评估。采用随机效应模型进行两两元分析和频率网络元分析。GRADE用于评估证据的确定性。结果纳入10项研究，共253名受试者。总体而言，在OFD中添加生物制剂可显著改善治疗后9-12个月的PPD和CAL，在低证据水平下，牙釉质基质衍生物（EMD）最有可能成为PPD变化的最佳生物制剂（-1.91 mm, 95% CI: -3.02, -0.81）和CAL （-2.24 mm, 95% CI: -2.68, -1.79）。结论：生物制剂的加入为治疗后PPD和CAL提供了辅助益处。然而，由于研究的异质性、可获得的数据有限、偏倚风险和低/中等证据，应谨慎解释数据。
{"title":"The efficacy of biologic factors on the surgical therapy of periodontal suprabony defects: A systematic review and network meta-analysis of randomized clinical trials.","authors":"Carrie Chew,Nikolaos Donos,Stefano Corbella,Isabella Manso,Greta Castellini,Elena Calciolari","doi":"10.1111/prd.70013","DOIUrl":"https://doi.org/10.1111/prd.70013","url":null,"abstract":"OBJECTIVESThis systematic review investigated the efficacy of biologic factors in the surgical treatment of periodontal suprabony defects.MATERIALS AND METHODSThree databases were searched to identify RCTs comparing open-flap debridement (OFD) combined with biologic factors only, or combined with bone substitute, and/or barriers to the same intervention without biologics or OFD in terms of probing pocket depth (PPD) reduction, clinical attachment level (CAL) gain, and number of pockets closed. Risk of bias was performed according to RoB 2. Pairwise meta-analyses and frequentist network meta-analyses by using random-effects models were performed. GRADE was employed to assess the certainty of evidence.RESULTSTen studies reporting on 253 subjects were included. Overall, adding biologics to OFD leads to a significant improvement in post-treatment PPD and CAL at 9-12 months, with enamel matrix derivative (EMD) having the highest probability of being the best biologic for changes in PPD (-1.91 mm, 95% CI: -3.02, -0.81) and CAL (-2.24 mm, 95% CI: -2.68, -1.79) at a low level of evidence.CONCLUSIONThe addition of biologics provides an adjunctive benefit in post-treatment PPD and CAL. However, data should be interpreted with caution due to the heterogeneity of studies, limited data available, risk of bias, and low/moderate evidence.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"96 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182635","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}
Nima Farshidfar,Mohammad Amin Amiri,Nathan E Estrin,Paras Ahmad,Yufeng Zhang,Anton Sculean,Richard J Miron
AIMThis narrative review aimed to gather evidence from comparative and non-comparative clinical studies to assess: (1) whether the administration of liquid platelet-rich fibrin (liquid PRF) provides any clinical benefits for managing temporomandibular disorders (TMD), and if so, based on comparative clinical studies, (2) whether it offers more benefits than no treatment or other treatment modalities, either as a standalone therapy or as an adjunct.MATERIALS AND METHODSTo compile all relevant data, we performed a systematic search of PubMed, Scopus, and Web of Science, supplemented by a Google Scholar search for gray literature and a manual screening of reference lists from eligible studies and relevant reviews, up to April 22, 2025. A total of 23 clinical studies (19 comparative and 4 non-comparative) were ultimately included in this review.RESULTSAcross the included studies, the administration of liquid PRF has been shown to have beneficial effects in reducing pain and enhancing maximum mouth opening (MMO) in patients with TMD. In the majority of studies, the adjunctive use of liquid PRF following arthrocentesis demonstrated greater positive effects compared with arthrocentesis alone. When used adjunctively with arthrocentesis, liquid PRF also showed comparable or superior clinical outcomes in terms of pain reduction and MMO improvement compared with platelet-rich plasma (PRP) and hyaluronic acid (HA).CONCLUSIONSBased on these findings, the administration of liquid PRF following arthrocentesis appears to be a promising approach for the management of TMD. To support clinical application, this review also presented a step-by-step protocol to guide dental and medical practitioners in the effective use of liquid PRF in patients with TMD. However, further well-designed randomized clinical trials with standardized methodologies are required to strengthen the evidence base and confirm the therapeutic benefits of liquid PRF in the management of TMD due to the high variability among the included studies.
本叙述性综述旨在收集比较和非比较临床研究的证据，以评估：(1)给予富血小板液体纤维蛋白（液体PRF）是否对颞下颌疾病（TMD）的治疗有任何临床益处，如果有，基于比较临床研究，(2)无论是作为单独治疗还是作为辅助治疗，它是否比不治疗或其他治疗方式更有益处。为了汇编所有相关数据，我们对PubMed、Scopus和Web of Science进行了系统搜索，并辅以谷歌Scholar搜索灰色文献和人工筛选符合条件的研究和相关综述的参考文献列表，时间截止到2025年4月22日。共有23项临床研究（19项比较研究和4项非比较研究）最终纳入本综述。结果在纳入的研究中，口服液体PRF已被证明对减轻TMD患者的疼痛和提高最大开口（MMO）有有益的作用。在大多数研究中，与单纯关节穿刺相比，关节穿刺后辅助使用液体PRF显示出更大的积极效果。与富血小板血浆（PRP）和透明质酸（HA）相比，当与关节穿刺辅助使用时，液体PRF在减轻疼痛和改善MMO方面也显示出相当或更好的临床结果。结论基于这些发现，关节穿刺后给予液体PRF似乎是治疗TMD的一种很有前途的方法。为了支持临床应用，本综述还提出了一个分步方案，指导牙科和医疗从业者在TMD患者中有效使用液体PRF。然而，由于纳入研究的高度可变性，需要进一步设计良好的随机临床试验，采用标准化的方法来加强证据基础，并确认液体PRF在TMD治疗中的治疗效果。
{"title":"Use of liquid platelet-rich fibrin (liquid PRF) in temporomandibular joint disorders: A narrative review with clinical recommendations.","authors":"Nima Farshidfar,Mohammad Amin Amiri,Nathan E Estrin,Paras Ahmad,Yufeng Zhang,Anton Sculean,Richard J Miron","doi":"10.1111/prd.70012","DOIUrl":"https://doi.org/10.1111/prd.70012","url":null,"abstract":"AIMThis narrative review aimed to gather evidence from comparative and non-comparative clinical studies to assess: (1) whether the administration of liquid platelet-rich fibrin (liquid PRF) provides any clinical benefits for managing temporomandibular disorders (TMD), and if so, based on comparative clinical studies, (2) whether it offers more benefits than no treatment or other treatment modalities, either as a standalone therapy or as an adjunct.MATERIALS AND METHODSTo compile all relevant data, we performed a systematic search of PubMed, Scopus, and Web of Science, supplemented by a Google Scholar search for gray literature and a manual screening of reference lists from eligible studies and relevant reviews, up to April 22, 2025. A total of 23 clinical studies (19 comparative and 4 non-comparative) were ultimately included in this review.RESULTSAcross the included studies, the administration of liquid PRF has been shown to have beneficial effects in reducing pain and enhancing maximum mouth opening (MMO) in patients with TMD. In the majority of studies, the adjunctive use of liquid PRF following arthrocentesis demonstrated greater positive effects compared with arthrocentesis alone. When used adjunctively with arthrocentesis, liquid PRF also showed comparable or superior clinical outcomes in terms of pain reduction and MMO improvement compared with platelet-rich plasma (PRP) and hyaluronic acid (HA).CONCLUSIONSBased on these findings, the administration of liquid PRF following arthrocentesis appears to be a promising approach for the management of TMD. To support clinical application, this review also presented a step-by-step protocol to guide dental and medical practitioners in the effective use of liquid PRF in patients with TMD. However, further well-designed randomized clinical trials with standardized methodologies are required to strengthen the evidence base and confirm the therapeutic benefits of liquid PRF in the management of TMD due to the high variability among the included studies.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"102 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145153484","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}
Lina J Suárez, R M Arce, Camila Pinheiro Furquim, Cristiane Gonçalves, Alpdogan Kantarci, Magda Feres, Nidia C Castro Dos Santos
Periodontitis is a chronic inflammatory disease affecting the supporting structures of the teeth. Although initiated by dysbiotic microbial communities, its progression is largely driven by the host's uncontrolled inflammatory response. While antibiotics have conventionally been employed in periodontitis therapy for their antimicrobial efficacy, emerging evidence suggests that certain antibiotics possess significant immune-modulatory properties independent of their bactericidal or bacteriostatic effects. This review explores the multifaceted immunomodulatory mechanisms by which various classes of antibiotics influence host immune cells and inflammatory pathways relevant to periodontal pathogenesis. Antibiotics were found to influence innate (e.g., pattern recognition receptors, neutrophils, macrophages, epithelial barriers, cytokine production) and acquired immunity (e.g., T and B cells). Additionally, they impact key osteoimmunology components, including interactions between immune and bone cells, the RANKL/osteoprotegerin pathway, and matrix metalloproteinase activity. Understanding the immunomodulatory actions of antibiotics enhances our understanding of their therapeutic potential in managing chronic inflammatory diseases, such as periodontitis. These properties may support inflammation resolution, immune regulation, and tissue repair, offering promising directions for future research and clinical application.
{"title":"Antibiotic-mediated immune modulation in periodontitis.","authors":"Lina J Suárez, R M Arce, Camila Pinheiro Furquim, Cristiane Gonçalves, Alpdogan Kantarci, Magda Feres, Nidia C Castro Dos Santos","doi":"10.1111/prd.70011","DOIUrl":"https://doi.org/10.1111/prd.70011","url":null,"abstract":"<p><p>Periodontitis is a chronic inflammatory disease affecting the supporting structures of the teeth. Although initiated by dysbiotic microbial communities, its progression is largely driven by the host's uncontrolled inflammatory response. While antibiotics have conventionally been employed in periodontitis therapy for their antimicrobial efficacy, emerging evidence suggests that certain antibiotics possess significant immune-modulatory properties independent of their bactericidal or bacteriostatic effects. This review explores the multifaceted immunomodulatory mechanisms by which various classes of antibiotics influence host immune cells and inflammatory pathways relevant to periodontal pathogenesis. Antibiotics were found to influence innate (e.g., pattern recognition receptors, neutrophils, macrophages, epithelial barriers, cytokine production) and acquired immunity (e.g., T and B cells). Additionally, they impact key osteoimmunology components, including interactions between immune and bone cells, the RANKL/osteoprotegerin pathway, and matrix metalloproteinase activity. Understanding the immunomodulatory actions of antibiotics enhances our understanding of their therapeutic potential in managing chronic inflammatory diseases, such as periodontitis. These properties may support inflammation resolution, immune regulation, and tissue repair, offering promising directions for future research and clinical application.</p>","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145054916","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}
BACKGROUNDUnderstanding periodontal diseases through a biological lens has been a central aim in periodontal research. Visionary pioneers in the field established the foundations of our knowledge, providing invaluable insights into disease mechanisms and progression.OBJECTIVEThis review highlights the evolving understanding of periodontal diseases, with particular focus on the transition from traditional diagnostic methods to molecular-based approaches.MATERIALS AND METHODSA narrative review was undertaken through a comprehensive literature search, synthesizing both historical perspectives and contemporary evidence.RESULTSOver recent decades, fundamental discoveries have significantly advanced our knowledge of periodontal pathogenesis. Despite this, current diagnostic protocols and classification systems remain largely reliant on clinical phenotypes such as pocket depth, attachment loss, and radiographic changes. These measures, while valuable, lack the precision to capture the underlying biological processes. To address this gap, a variety of biological samples (such as saliva, blood, gingival tissue and gingival crevicular fluid) have been explored as potential sources of diagnostic information. Investigations have identified diverse biomarkers, ranging from specific bacterial species and their products to host-derived enzymes, immune mediators, and tissue degradation products originating from the periodontal tissues. These findings colectively underscore the promise of molecular-based strategies to enhance disease detection and monitoring.CONCLUSIONThere is growing momentum toward the development of rapid, non-invasive, molecular diagnostic tools for periodontitis. Such approaches could not only enable earlier and more precise diagnosis within dentistry, but may also extend to applications in broader medical and non-dental settings.
{"title":"Biological definition of periodontal diseases: A historical review of host-response diagnostics and their implications for disease classification.","authors":"Nagihan Bostanci,Melissa M Grant,Moritz Kebschull","doi":"10.1111/prd.70005","DOIUrl":"https://doi.org/10.1111/prd.70005","url":null,"abstract":"BACKGROUNDUnderstanding periodontal diseases through a biological lens has been a central aim in periodontal research. Visionary pioneers in the field established the foundations of our knowledge, providing invaluable insights into disease mechanisms and progression.OBJECTIVEThis review highlights the evolving understanding of periodontal diseases, with particular focus on the transition from traditional diagnostic methods to molecular-based approaches.MATERIALS AND METHODSA narrative review was undertaken through a comprehensive literature search, synthesizing both historical perspectives and contemporary evidence.RESULTSOver recent decades, fundamental discoveries have significantly advanced our knowledge of periodontal pathogenesis. Despite this, current diagnostic protocols and classification systems remain largely reliant on clinical phenotypes such as pocket depth, attachment loss, and radiographic changes. These measures, while valuable, lack the precision to capture the underlying biological processes. To address this gap, a variety of biological samples (such as saliva, blood, gingival tissue and gingival crevicular fluid) have been explored as potential sources of diagnostic information. Investigations have identified diverse biomarkers, ranging from specific bacterial species and their products to host-derived enzymes, immune mediators, and tissue degradation products originating from the periodontal tissues. These findings colectively underscore the promise of molecular-based strategies to enhance disease detection and monitoring.CONCLUSIONThere is growing momentum toward the development of rapid, non-invasive, molecular diagnostic tools for periodontitis. Such approaches could not only enable earlier and more precise diagnosis within dentistry, but may also extend to applications in broader medical and non-dental settings.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"41 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145035996","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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