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}
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}
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