Journal of advanced periodontology & implant dentistry最新文献

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: This review evaluated the efficacy of various suturing techniques in gingival graft stabilization to optimize clinical outcomes and minimize the need for revision surgeries.

Methods: This scoping review was conducted across Scopus, PubMed, Cochrane, Web of Science, and ProQuest (through April 2025) using PICO criteria: Population (gingival grafts around teeth), Intervention (different suturing techniques), Comparison (efficacy of various suturing techniques in gingival graft stabilization), and Outcomes (keratinized tissue width [KTW], keratinized tissue height [KTH], and root coverage [RC]). From 838 initial records, 73 studies met the inclusion criteria after dual-reviewer screening with arbitration by a third reviewer. Study quality was assessed using the Joanna Briggs Institute tools.

Results: For free gingival grafts (FGGs), primary stabilization methods included interrupted sutures (with/without periosteal fixation), sling sutures, and cyanoacrylate. Connective tissue grafts (CTGs) predominantly use sling sutures, often combined with cross-mattress or interrupted sutures, vertical/double-cross mattress techniques, or continuous sutures with coronally advanced/tunnel flaps. While 72% of FGG studies (23/32) reported significant KTW improvement with interrupted sutures (a mean gain of 2.1±0.8 mm), CTG studies demonstrated 96% RC success (43/45) with sling-based techniques. However, outcomes showed substantial heterogeneity due to variability in the Miller classification (33/67 studies focused on Class I only) and inconsistent reporting of suture material (only 5/67 specified size/type).

Conclusion: No single suturing technique demonstrated clear superiority in graft stabilization, likely due to study heterogeneity. While sling/mattress combinations showed optimal RC for CTGs and interrupted sutures/cyanoacrylate performed well for FGGs, standardized RCTs controlling for confounding variables are required to establish definitive protocols.

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.

Background: This study aimed to assess the effectiveness of "a combined systemic and nonsurgical periodontal treatment" in eradicating gastric Helicobacter pylori in patients having the bacterium within their subgingival biofilm.

Methods: This randomized clinical trial (RCT) investigated 102 patients diagnosed with peptic ulcer or dyspepsia and a positive stomach test for H. pylori infection (G+). Participants with a negative test for oral infection received only triple therapy (G3, n=38), and those positive for oral infection were randomly allocated to one of the two treatment regimens: a 14-day course of triple therapy (comprising antibiotics, antimicrobials, and proton pump inhibitors) alongside periodontal therapy (G1, n=32) or triple therapy alone (G2, n=32). The effectiveness of H. pylori eradication was assessed four weeks after treatment using the H. pylori stool antigen (stool Ag) test. Data analysis was performed using SPSS 22.

Results: In the G2 and G3 groups, triple therapy achieved success rates of 52% and 84%, respectively. When periodontal therapy was integrated with triple therapy in the G1 group, the success rate was 80%. Significant differences were observed between the G1 and G2 groups (P=0.037) and also between the G3 and G2 groups (P=0.015). Conversely, no significant difference was found between the G1 and G3 groups (P>0.05).

Conclusion: Periodontal therapy has the potential to substantially increase the efficacy of H. pylori eradication regimens for gastric infections.

Background: The present study assessed the probing depth of the second molar distal aspect after the surgical removal of adjacent mandibular impacted third molars using osteotomy by a buccal window and routine crestal flaps.

Methods: In this double-blind, randomized clinical trial, 16 candidates for the surgical removal of bilateral mandibular third molars were selected, and each side's tooth was assigned to a different osteotomy group. The surgery was performed using a sulcular flap and a distal extension for one group, while the osteotomy was performed using the buccal window technique. The pocket probing depth of the adjacent second molars was calculated before and three months after the surgical removal. The data of both groups were statistically analyzed using normality and t-tests in the SPSS software. Statistical significance was set at P<0.05.

Results: At three months postoperatively, significant differences were found between the two groups regarding pocket probing depth at mesiobuccal (5.23±1.12 mm in the crestal osteotomy and 4.03±1.16 mm in the buccal window osteotomy; P<0.006), mid-distal (5.77±1.08 mm in the crestal osteotomy and 4.25±1.35 mm in the buccal window osteotomy; P<0.002), and distolingual aspects (5.46±1.34 mm in the crestal osteotomy and 3.96±1.11 mm in the crestal osteotomy; P<0.002) of the adjacent second molars. The mean pocket probing depth of the mid-distal area was significantly lower in the buccal window osteotomy.

Conclusion: According to the results, this technique can be used as an alternative to crestal osteotomy in level C impactions and Cl I and Cl II impactions regarding position towards the anterior edges of the mandibular ramus.