Andrea Pilloni, Yoshinori Shirakata, Lorenzo Marini, Darko Božić, Richard J Miron, Roberto Rotundo, Andreas Stavropoulos, Anton Sculean
<p><strong>Background: </strong>Although hyaluronic acid (HA) has long been used for many medical applications, only in recent years has it gained greater popularity in the field of periodontics because of its biological effects during wound healing. Even today, most clinicians are not aware that more than one type of HA exists and that the extent of its biological functions may vary depending upon the particular characteristics of the biomolecule itself.</p><p><strong>Aim: </strong>To review and synthesize the current preclinical and clinical evidence on the biological effects and therapeutic applications of HA in periodontology, with a focus on its role in wound healing and regeneration.</p><p><strong>Materials and methods: </strong>The origin and chemical structure of HA are discussed first, with a focus on the importance of its molecular weight and the possibility of modifying its structure and form. The main biological properties of HA followed by its effects on the cells of periodontal tissues are summarized and followed by the presentation of the results from preclinical studies in animals which have evaluated the effects of HA in various types of defects. Subsequently, the data from clinical studies evaluating the application of HA in nonsurgical periodontal therapy, regenerative periodontal surgery, and mucogingival surgery are summarized, and recommendations for the clinicians are provided.</p><p><strong>Results: </strong>The preclinical and clinical evidence indicates that HA accelerates the wound healing process through inflammatory mechanisms and enhances blood clot stability when applied to the root surface. It also influences the expression of both mineralized tissue markers and cementoblast-specific genes, suggesting a potential role in cementum regeneration. HA strongly promotes osteoprogenitor growth while maintaining stemness, potentially regulating the balance between self-renewal and differentiation during bone regeneration. Additionally, HA enhances periodontal ligament (PDL) cell adhesion and proliferation. It has been shown to improve the proliferative and migratory abilities of cells while inducing the expression of collagen type III alpha 1 (COL3A1) and TGFβ-3 genes, which are characteristic of scarless fetal wound healing. Certain HA formulations upregulate the expression of genes encoding platelet-derived growth factor B (PDGFB), fibroblast growth factor 2 (FGF-2), and epidermal growth factor (EGF), all of which play crucial roles in the healing process. Histologic evidence from animal studies suggests that HA may promote periodontal regeneration when applied both non-surgically and surgically-particularly in intrabony defects, gingival recessions, and, to some extent, in furcation defects. The data from clinical studies revealed that HA leads to statistically significant and clinically relevant improvements of probing depths and clinical attachment levels when used in conjunction with nonsurgical periodontal therapy a
{"title":"Hyaluronic acid: A novel approach in regenerative/reconstructive periodontal therapy?","authors":"Andrea Pilloni, Yoshinori Shirakata, Lorenzo Marini, Darko Božić, Richard J Miron, Roberto Rotundo, Andreas Stavropoulos, Anton Sculean","doi":"10.1111/prd.12644","DOIUrl":"https://doi.org/10.1111/prd.12644","url":null,"abstract":"<p><strong>Background: </strong>Although hyaluronic acid (HA) has long been used for many medical applications, only in recent years has it gained greater popularity in the field of periodontics because of its biological effects during wound healing. Even today, most clinicians are not aware that more than one type of HA exists and that the extent of its biological functions may vary depending upon the particular characteristics of the biomolecule itself.</p><p><strong>Aim: </strong>To review and synthesize the current preclinical and clinical evidence on the biological effects and therapeutic applications of HA in periodontology, with a focus on its role in wound healing and regeneration.</p><p><strong>Materials and methods: </strong>The origin and chemical structure of HA are discussed first, with a focus on the importance of its molecular weight and the possibility of modifying its structure and form. The main biological properties of HA followed by its effects on the cells of periodontal tissues are summarized and followed by the presentation of the results from preclinical studies in animals which have evaluated the effects of HA in various types of defects. Subsequently, the data from clinical studies evaluating the application of HA in nonsurgical periodontal therapy, regenerative periodontal surgery, and mucogingival surgery are summarized, and recommendations for the clinicians are provided.</p><p><strong>Results: </strong>The preclinical and clinical evidence indicates that HA accelerates the wound healing process through inflammatory mechanisms and enhances blood clot stability when applied to the root surface. It also influences the expression of both mineralized tissue markers and cementoblast-specific genes, suggesting a potential role in cementum regeneration. HA strongly promotes osteoprogenitor growth while maintaining stemness, potentially regulating the balance between self-renewal and differentiation during bone regeneration. Additionally, HA enhances periodontal ligament (PDL) cell adhesion and proliferation. It has been shown to improve the proliferative and migratory abilities of cells while inducing the expression of collagen type III alpha 1 (COL3A1) and TGFβ-3 genes, which are characteristic of scarless fetal wound healing. Certain HA formulations upregulate the expression of genes encoding platelet-derived growth factor B (PDGFB), fibroblast growth factor 2 (FGF-2), and epidermal growth factor (EGF), all of which play crucial roles in the healing process. Histologic evidence from animal studies suggests that HA may promote periodontal regeneration when applied both non-surgically and surgically-particularly in intrabony defects, gingival recessions, and, to some extent, in furcation defects. The data from clinical studies revealed that HA leads to statistically significant and clinically relevant improvements of probing depths and clinical attachment levels when used in conjunction with nonsurgical periodontal therapy a","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874478","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}
France Lambert,Eduardo Montero,Isabelle Laleman,Ana Carrillo de Albornoz,Haitam Yousfi,Ignacio Sanz-Sánchez
To explore the impact of soft tissue augmentation procedures during immediate implant placement (IIP) on clinician-assessed esthetic outcomes and patient-reported outcome measures (PROMs). A systematic literature search was conducted in PubMed, Cochrane Library, and Embase until March 2024. Two independent reviewers selected randomized and controlled clinical trials with ≥12 months follow-up, evaluating IIP in the premolar-to-premolar area with or without STA. Primary outcomes included esthetic assessments by clinicians (Pink Aesthetic Score, Implant Crown Aesthetic Index and mid-facial soft tissue recession) as well as PROMs. Secondary outcomes comprised post-operative morbidity, soft tissue stability, and interproximal bone changes. Data extraction was done by two independent reviewers, and the risk of bias was assessed using RoB 2.0 or ROBINS-I. Sixteen publications were included. The only relevant finding was that soft tissue augmentation significantly reduced midfacial soft tissue recession (n = 4, WMD = 0.38; 95% CI (0.15, 0.61)). No significant differences could be found between grafting and no grafting regarding the other clinician-assessed esthetic outcomes or for PROMs. Soft tissue augmentation during IIP reduces midfacial soft tissue recession. However, no other effects could be found based on clinician-assessed or patient-reported esthetic outcomes.
{"title":"Esthetic and patient-reported outcomes in immediate implants with adjunctive surgical procedures to increase soft tissue thickness/height: A systematic review.","authors":"France Lambert,Eduardo Montero,Isabelle Laleman,Ana Carrillo de Albornoz,Haitam Yousfi,Ignacio Sanz-Sánchez","doi":"10.1111/prd.70003","DOIUrl":"https://doi.org/10.1111/prd.70003","url":null,"abstract":"To explore the impact of soft tissue augmentation procedures during immediate implant placement (IIP) on clinician-assessed esthetic outcomes and patient-reported outcome measures (PROMs). A systematic literature search was conducted in PubMed, Cochrane Library, and Embase until March 2024. Two independent reviewers selected randomized and controlled clinical trials with ≥12 months follow-up, evaluating IIP in the premolar-to-premolar area with or without STA. Primary outcomes included esthetic assessments by clinicians (Pink Aesthetic Score, Implant Crown Aesthetic Index and mid-facial soft tissue recession) as well as PROMs. Secondary outcomes comprised post-operative morbidity, soft tissue stability, and interproximal bone changes. Data extraction was done by two independent reviewers, and the risk of bias was assessed using RoB 2.0 or ROBINS-I. Sixteen publications were included. The only relevant finding was that soft tissue augmentation significantly reduced midfacial soft tissue recession (n = 4, WMD = 0.38; 95% CI (0.15, 0.61)). No significant differences could be found between grafting and no grafting regarding the other clinician-assessed esthetic outcomes or for PROMs. Soft tissue augmentation during IIP reduces midfacial soft tissue recession. However, no other effects could be found based on clinician-assessed or patient-reported esthetic outcomes.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"27 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144819771","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}
For decades, osseous resective surgery along with apically positioned flap procedure has been advocated as a predictable treatment option to reduce residual pockets and minimize periodontal complications during supportive periodontal care. More recently, Fiber Retention Osseous Resective Surgery (FibReORS) has been suggested to reduce the amount of resected bone during flap surgery. The present review is aimed at assessing the potential advantages of FibReORS in terms of clinical and patient-related outcomes, thus focusing on the role of resective periodontal surgery in a modern clinical scenario.
{"title":"The European contribution to osseous resective surgery for the treatment of residual pockets and furcation defects.","authors":"Gianfranco Carnevale,Alberto Fonzar,Filippo Graziani,Francesco Cairo","doi":"10.1111/prd.70001","DOIUrl":"https://doi.org/10.1111/prd.70001","url":null,"abstract":"For decades, osseous resective surgery along with apically positioned flap procedure has been advocated as a predictable treatment option to reduce residual pockets and minimize periodontal complications during supportive periodontal care. More recently, Fiber Retention Osseous Resective Surgery (FibReORS) has been suggested to reduce the amount of resected bone during flap surgery. The present review is aimed at assessing the potential advantages of FibReORS in terms of clinical and patient-related outcomes, thus focusing on the role of resective periodontal surgery in a modern clinical scenario.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"35 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769537","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}
Francesco Cairo, Emilio Couso‐Queiruga, Luigi Barbato, Cosimo Rupe, Sandra Stuhr, Leandro Chambrone, Gustavo Avila‐Ortiz
To analyze the effect of root coverage surgical therapy for the treatment of single gingival recession defects (GRD) in terms of clinician‐ and patient‐reported outcomes (CROs and PROs), with an emphasis on esthetic perception. The protocol of this PRISMA 2020‐compliant systematic review was registered in PROSPERO (CRD517050). Relevant articles reporting the outcomes of randomized controlled trials (RCTs) were identified through a literature search. After final article selection, according to specific eligibility criteria, data were extracted and categorized. Primary outcomes were clinician‐reported root coverage esthetic scores (RES) and patient‐reported esthetic perception and satisfaction using different assessment methods, such as standardized visual analog scales (VAS). Data were analyzed and the risk of bias in all included studies was assessed. Fifty‐eight articles pertaining to 50 different RCTs were selected. A total of 1820 subjects presenting 2219 single GRDs were treated. Key findings derived from the pooled estimates indicated that root coverage and gingival phenotype modification therapy positively influenced both RES and patient‐reported esthetic perception and satisfaction values. Compared to the use of a coronally advanced flap (CAF) alone (i.e., monolaminar technique), the use of a CAF in conjunction with a subepithelial connective tissue graft (i.e., bilaminar technique) had a positive impact on both RES and VAS values, whereas CAF in conjunction with soft tissue substitutes only had a beneficial effect on VAS values. Surgical approaches based on lateral flap displacement were associated with superior mean RES values compared to techniques involving coronal flap displacement. Meta‐regression analyses revealed a statistically significant positive association between mean root coverage and RES (i.e., the greater the percentage of root coverage, the higher the RES). Conversely, the association between patient‐reported esthetic perception and MRC was not statistically significant. In addition, it was observed that dentinal hypersensitivity can be substantially reduced with surgical root coverage therapy, regardless of the treatment modality. Surgical therapy for the correction of single GRDs had a positive effect on both clinician‐reported esthetic scores and patient‐reported esthetic perception and satisfaction. Bilaminar techniques are generally associated with superior results.
{"title":"Clinician‐ and patient‐reported outcomes following the surgical treatment of single gingival recession defects: A systematic review","authors":"Francesco Cairo, Emilio Couso‐Queiruga, Luigi Barbato, Cosimo Rupe, Sandra Stuhr, Leandro Chambrone, Gustavo Avila‐Ortiz","doi":"10.1111/prd.12641","DOIUrl":"https://doi.org/10.1111/prd.12641","url":null,"abstract":"To analyze the effect of root coverage surgical therapy for the treatment of single gingival recession defects (GRD) in terms of clinician‐ and patient‐reported outcomes (CROs and PROs), with an emphasis on esthetic perception. The protocol of this PRISMA 2020‐compliant systematic review was registered in PROSPERO (CRD517050). Relevant articles reporting the outcomes of randomized controlled trials (RCTs) were identified through a literature search. After final article selection, according to specific eligibility criteria, data were extracted and categorized. Primary outcomes were clinician‐reported root coverage esthetic scores (RES) and patient‐reported esthetic perception and satisfaction using different assessment methods, such as standardized visual analog scales (VAS). Data were analyzed and the risk of bias in all included studies was assessed. Fifty‐eight articles pertaining to 50 different RCTs were selected. A total of 1820 subjects presenting 2219 single GRDs were treated. Key findings derived from the pooled estimates indicated that root coverage and gingival phenotype modification therapy positively influenced both RES and patient‐reported esthetic perception and satisfaction values. Compared to the use of a coronally advanced flap (CAF) alone (i.e., monolaminar technique), the use of a CAF in conjunction with a subepithelial connective tissue graft (i.e., bilaminar technique) had a positive impact on both RES and VAS values, whereas CAF in conjunction with soft tissue substitutes only had a beneficial effect on VAS values. Surgical approaches based on lateral flap displacement were associated with superior mean RES values compared to techniques involving coronal flap displacement. Meta‐regression analyses revealed a statistically significant positive association between mean root coverage and RES (i.e., the greater the percentage of root coverage, the higher the RES). Conversely, the association between patient‐reported esthetic perception and MRC was not statistically significant. In addition, it was observed that dentinal hypersensitivity can be substantially reduced with surgical root coverage therapy, regardless of the treatment modality. Surgical therapy for the correction of single GRDs had a positive effect on both clinician‐reported esthetic scores and patient‐reported esthetic perception and satisfaction. Bilaminar techniques are generally associated with superior results.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"27 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677549","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}
Alberto Monje,Ramon Pons,Ausra Ramanauskaite,Adriana Castro,Frank Schwarz,Leando Chambrone
BACKGROUNDTo assess the long-term results of the surgical treatment of peri-implantitis by means of clinical, radiographic outcomes, and whenever possible, a composite definition of disease resolution. Furthermore, this review aimed at evaluating the prognostic indicators of long-term disease recurrence.METHODSA systematic screening was conducted to identify long-term clinical studies (≥5 years) on the surgical therapy of peri-implantitis. Data pertinent to study methodology, surgical intervention and clinical and radiographic outcomes were retrieved from the original studies. Qualitative assessment was performed.RESULTSOverall, 17 long-term studies were included in the qualitative synthesis. Due to the heterogeneity, quantitative analysis was not suggested. The mean disease resolution rate was 58.6%. The mean progressive bone loss arrestment (>1 mm) at the latest follow-up following therapy was reached in 69.6%. Resolution of bleeding on probing at the latest follow-up was achieved in 59.9%. The need for retreatment was deemed in 27.2% of the cases. Disease resolution following a second attempt was seldomly evaluated. The implant survival rate resulted in 88.6% (range: 75%-100%). The odds for disease recurrence following surgical treatment of peri-implantitis were ∼8× higher when residual pathogenic pockets were present during follow-up. Moreover, the extent of bone loss, the width (<2 mm) of keratinized mucosa following surgical treatment, and implant surface (modified) influenced disease recurrence.CONCLUSIONThe surgical treatment of peri-implantitis yields to favorable outcomes in the long-term. Data suggest that the long-term disease resolution is ∼60% under supportive peri-implant care, while ∼70% exhibit progressive bone loss arrestment. Hence, the need for retreatment is not infrequent. Residual pockets (≥6 mm) following surgical therapy and the advanced extent of bone loss imply a risk for disease recurrence.CLINICAL RELEVANCEThese findings suggest that the surgical treatment of peri-implantitis is effective in the long-term in patients enrolled in supportive peri-implant therapy. However, its predictability can be interfered in scenarios exhibiting advanced lesions or in those that display residual deep pockets following therapy.
{"title":"Long-term surgical treatment outcomes of peri-implantitis.","authors":"Alberto Monje,Ramon Pons,Ausra Ramanauskaite,Adriana Castro,Frank Schwarz,Leando Chambrone","doi":"10.1111/prd.12643","DOIUrl":"https://doi.org/10.1111/prd.12643","url":null,"abstract":"BACKGROUNDTo assess the long-term results of the surgical treatment of peri-implantitis by means of clinical, radiographic outcomes, and whenever possible, a composite definition of disease resolution. Furthermore, this review aimed at evaluating the prognostic indicators of long-term disease recurrence.METHODSA systematic screening was conducted to identify long-term clinical studies (≥5 years) on the surgical therapy of peri-implantitis. Data pertinent to study methodology, surgical intervention and clinical and radiographic outcomes were retrieved from the original studies. Qualitative assessment was performed.RESULTSOverall, 17 long-term studies were included in the qualitative synthesis. Due to the heterogeneity, quantitative analysis was not suggested. The mean disease resolution rate was 58.6%. The mean progressive bone loss arrestment (>1 mm) at the latest follow-up following therapy was reached in 69.6%. Resolution of bleeding on probing at the latest follow-up was achieved in 59.9%. The need for retreatment was deemed in 27.2% of the cases. Disease resolution following a second attempt was seldomly evaluated. The implant survival rate resulted in 88.6% (range: 75%-100%). The odds for disease recurrence following surgical treatment of peri-implantitis were ∼8× higher when residual pathogenic pockets were present during follow-up. Moreover, the extent of bone loss, the width (<2 mm) of keratinized mucosa following surgical treatment, and implant surface (modified) influenced disease recurrence.CONCLUSIONThe surgical treatment of peri-implantitis yields to favorable outcomes in the long-term. Data suggest that the long-term disease resolution is ∼60% under supportive peri-implant care, while ∼70% exhibit progressive bone loss arrestment. Hence, the need for retreatment is not infrequent. Residual pockets (≥6 mm) following surgical therapy and the advanced extent of bone loss imply a risk for disease recurrence.CLINICAL RELEVANCEThese findings suggest that the surgical treatment of peri-implantitis is effective in the long-term in patients enrolled in supportive peri-implant therapy. However, its predictability can be interfered in scenarios exhibiting advanced lesions or in those that display residual deep pockets following therapy.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"18 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684148","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}
José Nart,Cristina Valles,Javi Vilarrasa,Federica Romano,Giacomo Baima,Mario Aimetti
The aim of this systematic review was to assess the performance of soft tissue augmentation (STA) procedures, with or without a modification of the prosthetic rehabilitation, for the treatment of buccal peri-implant soft tissue dehiscence (PSTD) in terms of esthetics and patient-reported outcomes. A systematic review protocol was developed following the PRISMA checklist. Electronic and hand searches were conducted to identify randomized clinical trials (RCTs) and prospective studies on the treatment of buccal PSTD in implants without peri-implantitis, with a follow-up of at least 6 months. Professional assessment of esthetics and self-reported patient satisfaction were considered the primary outcomes, while clinical variables were considered secondary outcomes. Meta-analysis was carried out when possible using a fixed- or random-effect model. Eight publications reporting on five studies (two RCTs and three prospective studies), published from 2013 to 2024 and including a total of 87 patients, were included in this systematic review. All studies evaluated a coronally advanced flap (CAF) with connective tissue graft (CTG) or substitutes, whereas one arm of an RCT employed a tunnel procedure. Two studies included changing of the prosthetic component. Three studies were rated at low risk of bias. A total of 10 meta-analyses were performed. STA using CAF achieved a final professional esthetic score of 7.7 on a 0-10 scale (95% CI: 6.63; 8.83) and showed improvements in terms of patient-reported esthetics on a 0-100 visual analogue scale (60.8; 95% CI: 46.56; 75.01), with moderate-to-high heterogeneity. The estimated reduction in PSTD depth was 2.2 mm (95% CI: 1.76; 2.69), with an estimated rate of complete PSTD coverage of 71% (95% CI: 59; 82). Based on limited evidence, it can be concluded that STA procedures around implants affected by buccal PSTD appear to positively influence both professional and patient-reported esthetics outcomes.
{"title":"Impact of soft tissue augmentation procedures on esthetics and patient satisfaction in the treatment of peri-implant buccal soft tissue dehiscences: A systematic review and meta-analysis.","authors":"José Nart,Cristina Valles,Javi Vilarrasa,Federica Romano,Giacomo Baima,Mario Aimetti","doi":"10.1111/prd.12633","DOIUrl":"https://doi.org/10.1111/prd.12633","url":null,"abstract":"The aim of this systematic review was to assess the performance of soft tissue augmentation (STA) procedures, with or without a modification of the prosthetic rehabilitation, for the treatment of buccal peri-implant soft tissue dehiscence (PSTD) in terms of esthetics and patient-reported outcomes. A systematic review protocol was developed following the PRISMA checklist. Electronic and hand searches were conducted to identify randomized clinical trials (RCTs) and prospective studies on the treatment of buccal PSTD in implants without peri-implantitis, with a follow-up of at least 6 months. Professional assessment of esthetics and self-reported patient satisfaction were considered the primary outcomes, while clinical variables were considered secondary outcomes. Meta-analysis was carried out when possible using a fixed- or random-effect model. Eight publications reporting on five studies (two RCTs and three prospective studies), published from 2013 to 2024 and including a total of 87 patients, were included in this systematic review. All studies evaluated a coronally advanced flap (CAF) with connective tissue graft (CTG) or substitutes, whereas one arm of an RCT employed a tunnel procedure. Two studies included changing of the prosthetic component. Three studies were rated at low risk of bias. A total of 10 meta-analyses were performed. STA using CAF achieved a final professional esthetic score of 7.7 on a 0-10 scale (95% CI: 6.63; 8.83) and showed improvements in terms of patient-reported esthetics on a 0-100 visual analogue scale (60.8; 95% CI: 46.56; 75.01), with moderate-to-high heterogeneity. The estimated reduction in PSTD depth was 2.2 mm (95% CI: 1.76; 2.69), with an estimated rate of complete PSTD coverage of 71% (95% CI: 59; 82). Based on limited evidence, it can be concluded that STA procedures around implants affected by buccal PSTD appear to positively influence both professional and patient-reported esthetics outcomes.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"16 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645921","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}
Zhaozhao Chen,Lan-Lin Chiou,Javier Calatrava,Hom-Lay Wang
Antibiotics are commonly prescribed in periodontal and implant surgeries, either before, during or after surgery, to prevent postoperative infection and reduce early implant failure. However, the potential benefits may be undermined by the risks of resistance and sensitization, thus requiring a strict indication for prescription. There are controversial views regarding the indication, dosage, duration, and timing of antibiotic medication in periodontal and implant surgery. Therefore, the aim of this review is to address the benefits and concerns regarding the efficacy of using preventive antibiotic therapy in Periodontology and Implant Dentistry. Specifically, various types of procedures were comprehensively explored, and recommendations were given accordingly. The available evidence indicates that preventive antibiotic therapy is not warranted for periodontal surgeries, including conventional, plastic, and regenerative procedures. While antibiotic prophylaxis has shown effectiveness in preventing early implant failures in straightforward implant placements, postoperative coverage does not appear to be justified. Furthermore, antibiotic administration has not proven to significantly reduce early implant failure rates in implant placements involving simultaneous guided bone regeneration. There remains insufficient evidence to support or oppose the use of preventive antibiotic therapy for reducing infection rates after ridge or sinus augmentation procedures, nor is there evidence favoring any specific protocol over others.
{"title":"The role of antibiotics in preventing surgical complications in periodontology and implant dentistry.","authors":"Zhaozhao Chen,Lan-Lin Chiou,Javier Calatrava,Hom-Lay Wang","doi":"10.1111/prd.12636","DOIUrl":"https://doi.org/10.1111/prd.12636","url":null,"abstract":"Antibiotics are commonly prescribed in periodontal and implant surgeries, either before, during or after surgery, to prevent postoperative infection and reduce early implant failure. However, the potential benefits may be undermined by the risks of resistance and sensitization, thus requiring a strict indication for prescription. There are controversial views regarding the indication, dosage, duration, and timing of antibiotic medication in periodontal and implant surgery. Therefore, the aim of this review is to address the benefits and concerns regarding the efficacy of using preventive antibiotic therapy in Periodontology and Implant Dentistry. Specifically, various types of procedures were comprehensively explored, and recommendations were given accordingly. The available evidence indicates that preventive antibiotic therapy is not warranted for periodontal surgeries, including conventional, plastic, and regenerative procedures. While antibiotic prophylaxis has shown effectiveness in preventing early implant failures in straightforward implant placements, postoperative coverage does not appear to be justified. Furthermore, antibiotic administration has not proven to significantly reduce early implant failure rates in implant placements involving simultaneous guided bone regeneration. There remains insufficient evidence to support or oppose the use of preventive antibiotic therapy for reducing infection rates after ridge or sinus augmentation procedures, nor is there evidence favoring any specific protocol over others.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"10 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639950","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}
Yi Te Lin, Chenshuang Li, Jonathan Korostoff, Joseph P. Fiorellini, Jie Yang, Yu‐Cheng Chang
3D digital evaluation of the periodontal and peri‐implant tissue, including CBCT, intraoral scanning, optical surface scanning, and ultrasonography, is being used in the clinical arena with increasing frequency. Thus, to validate the utilization of 3D digital analysis for this purpose, a critical evaluation of the reliability of digital approaches relative to conventional methodologies is necessary. Therefore, the goal of the present review is to provide a summary of the existing literature addressing the use of CBCT and intraoral scanning to evaluate the periodontal and peri‐implant tissues, highlighting both the advantages and disadvantages of 3D digital methodologies versus conventional approaches. A synopsis of currently available hardware and software is provided. Finally, the review discusses the implications of artificial intelligence in the future development of digital technology for assessing the structures of the periodontal and peri‐implant tissue. This review provides a foundation for understanding current 3D digital analysis approaches for the evaluation of periodontal and peri‐implant phenotype. While current CBCT and intraoral scanning technologies provide accurate quantitative measurements comparable to conventional methods, the full potential of 3D digital clinical data has not been undermined. Future advancement requires a fundamental shift in how we conceptualize and analyze periodontal and peri‐implant tissue relationships in three‐dimensional space, moving beyond conventional evaluation protocols. Integration of artificial intelligence and deep learning tools with these comprehensive 3D datasets in the future will enable more precise diagnosis and treatment outcome assessment, revolutionizing how we evaluate periodontal and peri‐implant phenotypes.
{"title":"Three‐dimensional digital quantitative analysis of periodontal and peri‐implant phenotype—A narrative review","authors":"Yi Te Lin, Chenshuang Li, Jonathan Korostoff, Joseph P. Fiorellini, Jie Yang, Yu‐Cheng Chang","doi":"10.1111/prd.12639","DOIUrl":"https://doi.org/10.1111/prd.12639","url":null,"abstract":"3D digital evaluation of the periodontal and peri‐implant tissue, including CBCT, intraoral scanning, optical surface scanning, and ultrasonography, is being used in the clinical arena with increasing frequency. Thus, to validate the utilization of 3D digital analysis for this purpose, a critical evaluation of the reliability of digital approaches relative to conventional methodologies is necessary. Therefore, the goal of the present review is to provide a summary of the existing literature addressing the use of CBCT and intraoral scanning to evaluate the periodontal and peri‐implant tissues, highlighting both the advantages and disadvantages of 3D digital methodologies versus conventional approaches. A synopsis of currently available hardware and software is provided. Finally, the review discusses the implications of artificial intelligence in the future development of digital technology for assessing the structures of the periodontal and peri‐implant tissue. This review provides a foundation for understanding current 3D digital analysis approaches for the evaluation of periodontal and peri‐implant phenotype. While current CBCT and intraoral scanning technologies provide accurate quantitative measurements comparable to conventional methods, the full potential of 3D digital clinical data has not been undermined. Future advancement requires a fundamental shift in how we conceptualize and analyze periodontal and peri‐implant tissue relationships in three‐dimensional space, moving beyond conventional evaluation protocols. Integration of artificial intelligence and deep learning tools with these comprehensive 3D datasets in the future will enable more precise diagnosis and treatment outcome assessment, revolutionizing how we evaluate periodontal and peri‐implant phenotypes.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"21 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603084","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}
João Gabriel S Souza,Bruna E Nagay,Rodrigo Martins,Martinna Bertolini,Jamil A Shibli,Conrado Aparicio,Magda Feres,Valentim A R Barão
When exposed to the oral environment, dental implants, like natural surfaces, become substrates for microbial adhesion and accumulation, often leading to implant-related infections-one of the main causes of implant failure. These failures impose significant costs on patients, clinicians, and healthcare systems. Despite extensive research, there is no consensus on the most effective protocol for managing peri-implantitis. Biomedical engineering has aimed to address this challenge by developing biocompatible implants with surface properties designed to enhance biological responses and reduce polymicrobial accumulation. Due to the complexity of interactions between implants and biological systems, no single material property can drive these processes. Instead, a combination of physical, chemical, and mechanical properties is required to ensure a safe and effective response. Antimicrobial coatings are developed either by incorporating antimicrobial agents onto surfaces or modifying the material's physicochemical properties. These coatings utilize a range of compounds for contact-killing or as drug-delivery systems. While biomaterials science has advanced rapidly in enhancing implant surfaces, these bioengineering techniques have progressed more rapidly than our understanding of the pathogenesis of implant infections. To bridge this gap, biomedical engineering must address emerging knowledge about implant infections, focusing on controlling microbial accumulation while simultaneously managing inflammatory responses to support tissue healing. This review critically evaluates current evidence on implant infection pathogenesis, antimicrobial coating technologies, and systematically assesses their in vivo (animal and human evidence) efficacy to guide future advancements in implant infection mitigation.
{"title":"Engineered surface strategies to manage dental implant-related infections.","authors":"João Gabriel S Souza,Bruna E Nagay,Rodrigo Martins,Martinna Bertolini,Jamil A Shibli,Conrado Aparicio,Magda Feres,Valentim A R Barão","doi":"10.1111/prd.12637","DOIUrl":"https://doi.org/10.1111/prd.12637","url":null,"abstract":"When exposed to the oral environment, dental implants, like natural surfaces, become substrates for microbial adhesion and accumulation, often leading to implant-related infections-one of the main causes of implant failure. These failures impose significant costs on patients, clinicians, and healthcare systems. Despite extensive research, there is no consensus on the most effective protocol for managing peri-implantitis. Biomedical engineering has aimed to address this challenge by developing biocompatible implants with surface properties designed to enhance biological responses and reduce polymicrobial accumulation. Due to the complexity of interactions between implants and biological systems, no single material property can drive these processes. Instead, a combination of physical, chemical, and mechanical properties is required to ensure a safe and effective response. Antimicrobial coatings are developed either by incorporating antimicrobial agents onto surfaces or modifying the material's physicochemical properties. These coatings utilize a range of compounds for contact-killing or as drug-delivery systems. While biomaterials science has advanced rapidly in enhancing implant surfaces, these bioengineering techniques have progressed more rapidly than our understanding of the pathogenesis of implant infections. To bridge this gap, biomedical engineering must address emerging knowledge about implant infections, focusing on controlling microbial accumulation while simultaneously managing inflammatory responses to support tissue healing. This review critically evaluates current evidence on implant infection pathogenesis, antimicrobial coating technologies, and systematically assesses their in vivo (animal and human evidence) efficacy to guide future advancements in implant infection mitigation.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"9 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144578582","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}
G Avila-Ortiz,E Couso-Queiruga,S Stuhr,L Chambrone
This systematic review analyzed the long-term outcomes of alveolar ridge preservation (ARP) and alveolar ridge reconstruction (ARR) before delayed implant placement. Eight studies were included (one non-randomized clinical trial, one prospective case series, four retrospective comparative studies, and two retrospective case series). Risk of bias assessment, using a modified Newcastle-Ottawa Scale, revealed one high-quality study, four medium-quality studies, and three with low methodological quality. In total, 333 patients underwent ARP or ARR, with the most common approach involving xenogeneic bone grafting and socket sealing with a collagen membrane, matrix, or dressing. Follow-up ranged from 5 to 10 years. Due to methodological heterogeneity and limited data, quantitative analysis was not feasible. The implant survival rate was the most frequently reported outcome, followed by peri-implant marginal bone level changes and peri-implant disease incidence. Despite limited evidence, ARP and ARR appear to support favorable long-term outcomes, particularly in implant survival and bone stability. Further well-designed, large-scale studies comparing different ARP and ARR modalities with other therapies are needed to guide clinical decision-making.
{"title":"Long-term outcomes of post-extraction alveolar ridge preservation and alveolar ridge reconstruction followed by delayed implant placement: A systematic review.","authors":"G Avila-Ortiz,E Couso-Queiruga,S Stuhr,L Chambrone","doi":"10.1111/prd.12642","DOIUrl":"https://doi.org/10.1111/prd.12642","url":null,"abstract":"This systematic review analyzed the long-term outcomes of alveolar ridge preservation (ARP) and alveolar ridge reconstruction (ARR) before delayed implant placement. Eight studies were included (one non-randomized clinical trial, one prospective case series, four retrospective comparative studies, and two retrospective case series). Risk of bias assessment, using a modified Newcastle-Ottawa Scale, revealed one high-quality study, four medium-quality studies, and three with low methodological quality. In total, 333 patients underwent ARP or ARR, with the most common approach involving xenogeneic bone grafting and socket sealing with a collagen membrane, matrix, or dressing. Follow-up ranged from 5 to 10 years. Due to methodological heterogeneity and limited data, quantitative analysis was not feasible. The implant survival rate was the most frequently reported outcome, followed by peri-implant marginal bone level changes and peri-implant disease incidence. Despite limited evidence, ARP and ARR appear to support favorable long-term outcomes, particularly in implant survival and bone stability. Further well-designed, large-scale studies comparing different ARP and ARR modalities with other therapies are needed to guide clinical decision-making.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"20 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547856","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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