Journal of advanced periodontology & implant dentistry最新文献

Background: Peri-implantitis remains a clinically relevant complication characterized by soft tissue inflammation and progressive bone loss. Existing classification systems vary in their emphasis on clinical severity or defect morphology and seldom provide operational, treatment-linked guidance-particularly for apical disease.

Methods: We conducted a structured critical review of PubMed, Scopus, and Web of Science for studies published in English from January 1990 to December 2023 (last search: December 31, 2023). Full search strategies are reported in Supplementary file 1. Grey literature and conference abstracts were excluded a priori. Two reviewers independently screened records in consensus; a PRISMA-style flow diagram summarizes the selection process. Using a predefined rubric (domains covered, anchors, required inputs, treatment linkage, validation/reliability), we synthesized ten published classification systems (2004-2019) and complemented them with one proposed framework.

Results: Across systems, recurrent gaps included limited integration of clinical parameters with radiographic morphology, inconsistent coverage of implant apical lesions (IALs), and sparse, non-graded treatment guidance. We therefore introduce a three-dimensional framework that classifies lesions as crestal, apical (IAL), or lateral, each with severity strata and operational thresholds (radiographic bone loss relative to functional implant length:<25%, 25-50%,>50%). A standardized measurement protocol is specified (paralleling periapical radiographs as default; selective cone beam computed tomography (CBCT) for suspected buccal/facial dehiscence or equivocal lateral defects), with rules for cases lacking baseline radiographs. A one-page decision algorithm links categories to management options whose strength of recommendation follows the EFP 2023 S3 guideline; laser use is presented as an adjunct where evidence is mixed. Three clinical vignettes illustrate how the framework informs treatment planning. Plans for inter-rater reliability testing are outlined.

Conclusion: This review consolidates and contrasts existing systems and offers an implementable, consensus-aligned framework that unifies morphology, severity, and apical disease with transparent, evidence-graded treatment pathways. Prospective validation and reliability studies are warranted.

Background: A well-documented positive correlation exists between salivary cortisol levels (SCLs) and periodontal disease. Given the clinical and pathophysiological similarities between peri-implant diseases and periodontal conditions, this study aimed to explore the association between SCLs and peri-implant mucositis and peri-implantitis.

Methods: An analytical observational study was conducted involving 86 patients who had been using dental prostheses for a minimum of one year. Unstimulated salivary samples were collected from all the participants. Clinical assessments included periodontal probing depth (PPD), papilla bleeding index (PBI), Mombelli modified plaque index (mPI), and radiographic evaluation of bone loss. Based on clinical and radiographic findings, the subjects were categorized into three groups: (1) individuals with healthy peri-implant tissues, (2) patients with peri-implant mucositis, and (3) patients with peri-implantitis. Salivary cortisol concentrations were quantified using an enzyme-linked immunosorbent assay (ELISA). Statistical analysis was conducted using one-way analysis of variance (ANOVA), followed by independent t-tests and post hoc Tukey comparisons.

Results: Significant differences were observed in mean PPD values between the three groups (P<0.05), with the peri-implantitis group exhibiting the highest values. Likewise, mPI scores varied significantly across the groups (P<0.05). However, no significant differences were detected in SCLs between the three groups.

Conclusion: Within the limitations of this study, no significant association was identified between SCLs and peri-implant disease. Further studies with larger sample sizes and longitudinal designs are recommended to validate these findings.

This case report describes the rehabilitation of a 70-year-old Arab male patient with relapsing-remitting multiple sclerosis (MS), controlled type 2 diabetes, and heavy smoking. The patient was treated with a maxillary four-implant bar-supported overdenture and a mandibular two-implant tissue-supported overdenture chosen for their stability, minimal invasiveness, affordability, and ease of hygiene. At three-year follow-up, peri-implant bone levels remained stable, and function and quality of life improved. However, moderate inflammation and plaque accumulation reflected fair oral hygiene and persistent smoking. This case emphasizes the need for strict maintenance at three-month intervals and elimination of risk factors, particularly smoking and poor glycemic control. Implant therapy in MS patients should be undertaken cautiously with comprehensive risk assessment and interdisciplinary planning. Although this single case showed favorable outcomes, the findings should be interpreted with caution, given the persistent high-risk factors and limited generalizability.

Background: Gingival recession is a common mucogingival condition that may cause esthetic concerns, root sensitivity, and functional problems. Tunneling techniques with connective tissue grafts (CTGs) are well established for root coverage and esthetic preservation. Various suspensory sutures have been proposed to stabilize coronally advanced flaps. The butterfly suture is a modified anchored approach intended to provide simultaneous stabilization of interproximal and midfacial areas. This case series describes the clinical application and short-term outcomes of this technique.

Methods: Three systemically healthy patients (two males and one female, aged 20-45 years) with Cairo RT1 and RT2 recession defects were treated using a tunneling technique combined with CTG and stabilized with the butterfly suture. The patients were followed for 6 weeks, and outcomes were assessed descriptively.

Results: Nine teeth were treated in the three patients. Seven defects achieved complete root coverage (CRC), and two achieved partial root coverage (PRC). Healing was uneventful in all cases, with no complications such as infection or necrosis. The patients reported satisfaction with the esthetic outcomes and resolution of dentin hypersensitivity.

Conclusion: Within the limitations of this small case series, the butterfly suture provided stable coronal advancement and favorable root coverage outcomes. This technique may represent a simple and efficient alternative in tunneling procedures. Larger controlled studies with longer follow-up and patient-reported outcomes are necessary to validate its effectiveness.

This narrative review summarizes recent advances in in situ gel drug delivery systems for periodontal therapy, focusing on formulation strategies, the pharmaceutical agents involved, and their clinical applications. A comprehensive search was conducted on PubMed, Scopus, and Google Scholar for English-language articles published from 2000 to 2024 using relevant keywords. Articles were selected based on their clinical significance, scientific rigor, and relevance to periodontal treatment. In situ gels use physiological stimuli such as pH, temperature, or ions for sol-to-gel transition, enabling sustained and localized drug release into periodontal pockets. These systems aim to improve therapeutic efficacy and reduce systemic side effects. However, limitations like inconsistent gelation, low mechanical strength, and limited long-term clinical data hinder widespread clinical adoption. Future research should focus on formulation optimization and rigorous clinical trials to facilitate the integration of in-situ gels into routine periodontal care.

Background: Suture materials in the oral cavity can promote bacterial adhesion and contamination. While antimicrobial-coated sutures are effective, their use is limited by cost, availability, and toxicity. Platelet-rich fibrin (PRF) derivatives have shown antimicrobial activity against periodontal pathogens. This study compared the antimicrobial efficacy of sutures soaked in saline, i-PRF, and PRF lysate.

Methods: An in vitro study was used to determine the minimum inhibitory concentration (MIC) of sutures soaked in saline, i-PRF, and PRF lysate. The sutures were tested against Streptococcus mutans, Prevotella intermedia, and Porphyromonas gingivalis by measuring inhibition zones. Non-absorbable 3-0 black silk sutures were cut and soaked for 10 minutes in saline (group A), i-PRF (group B), or PRF lysate (group C), then incubated anaerobically at 37 °C for 24 hours. Additionally, samples from all three groups were incubated at 37 °C in 5 mL of saliva from patients with chronic periodontitis, and colony-forming units (CFUs) were assessed on days 1, 3, 5, and 7.

Results: Sutures soaked in i-PRF and PRF lysate demonstrated a statistically significant increase in the zone of inhibition and a reduction in CFU against S. mutans, P. intermedia, and P. gingivalis. Scanning electron microscopy analyses showed a fibrin network on sutures soaked in i-PRF and PRF lysate.

Conclusion: The antimicrobial efficacy of i-PRF- and PRF lysate-treated sutures against oral pathogens appears promising. These biologically enhanced sutures may serve as effective alternatives to conventional antimicrobial sutures.

Background: Periodontal and peri-implant soft tissue management in oral rehabilitation is often necessary to achieve more esthetic and stable clinical results. This involves harvesting connective tissue from the palate. There is no consensus about the technique that will cause less postoperative pain in the donor area. Thus, this prospective cohort study compared the postoperative morbidity of two surgical techniques from the palate donor site: the free gingival graft (FGG)/de-epithelialized technique and the linear technique/subepithelial technique.

Methods: Sixteen patients were randomly assigned to the FGG/de-epithelialized removal group (G1) and the removal of the connective tissue graft (CTG) with the linear/subepithelial technique group (G2). The morbidity analysis consisted of measuring the number of anti-inflammatory agents taken in the postoperative period, pain analysis through a visual analog scale, and visual analysis of healing of palatal soft tissues 1, 2, and 3 weeks after surgery.

Results: The results showed that the G1 patients took more anti-inflammatory drugs (mean=9.88) than the G2 (mean=3.63) and experienced more postoperative pain (mean=6.38) than G2 (mean=3) (P<0.05 for both parameters). In the visual analysis of healing, the results were better for G1 on days 7 and 21; however, on day 14, the results were better for G2, with no significant differences (P>0.05) between the groups at any of the experimental times.

Conclusion: Both techniques promoted effective healing of the palatal area; however, the removal by the linear graft technique caused less postoperative pain.

Background: This study investigated the optimal placement of mini-implants in the mandibular buccal shelf and infra-zygomatic crest regions using finite element analysis.

Methods: Three-dimensional finite element method (FEM) models of bone and mini-implants were created. In the mandibular buccal shelf (MBS) region, mini-screws were positioned at three sites: between the first molar roots, between the second molar roots, and distal to the second molar, tested at two depths (4 mm and 8 mm) and two angles to the occlusal plane (60° and 90°). In the infra-zygomatioc crest (IZC) region, mini-screws were placed between the first and second maxillary molars and adjacent to the mesiobuccal root of the second molar, at depths of 7 mm and 11 mm, and angles of 40° and 75° relative to the occlusal surface. The force of 200 g was applied as immediate loading and in a vertical direction to the center of the miniscrew.

Results: In the MBS region, the distal second molar site at 8 mm depth and 60° angle exhibited the lowest von Mises stress, while the lowest strain occurred between the first molar roots at the same depth and angle. In the IZC region, the best biomechanical response was found at 7-mm depth between the first and second molars at a 75° angle, with the highest stress occurring near the mesiobuccal root of the second molar at 11-mm depth and 40° angle.

Conclusion: These findings suggest that for optimal biomechanical performance, MBS mini-screws should be placed distal to the second molar at 4-8-mm depth and 60° angle, and IZC mini-screws between the first and second molars at 7-mm depth and 75° angle.