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Purpose: To describe a digital workflow for the management of the emergence profile and the restoration's finishing line on vertically prepared teeth using a digital data set. Materials and Methods: Three scans (the prepared teeth the day of the preparation, the provisional restoration placed on the preparation after soft tissue maturation, and the provisional restoration outside of the oral cavity) were combined under a common data set to provide the necessary information to design the final restoration. Results: The digital technique presented can facilitate the implementation of the vertical preparation, because the desired finish line can be defined by the clinician and be transferred predictably to the dental lab. The current approach provides an alternative gingival management method, taking advantage of the displacement of soft tissue after vertical preparation. Conclusions: Positioning of the final finishing line on vertically prepared teeth, management of soft tissue, and fabrication of the final restoration can be facilitated with this approach, combining a digital data set that has been obtained during a distinct phase of the treatment. [ABSTRACT FROM AUTHOR]

This study aimed to determine the correlation between gingival stippling (GS) and other phenotypic characteristics. Adult subjects in need of CBCT scans and comprehensive dental treatment in the anterior maxilla were recruited. Facial gingival thickness (GT) and buccal bone thickness (BT) were assessed utilizing CBCT. Standardized intraoral photographs were obtained to determine keratinized tissue width (KTW), presence of GS in all facial and interproximal areas between the maxillary canines, and other variables of interest, such as gingival architecture (GA), tooth shape, and location. Statistical analyses were conducted to assess different correlations among recorded variables. A total of 100 participants and 600 maxillary anterior teeth constituted the study population and sample, respectively. Facial GS was observed in 56% of men and 44% of women, and it was more frequently associated with flat GA, triangular and square/tapered teeth, central incisors, and men. Greater mean GT, BT, and KTW values were observed in facial areas that exhibited GS. Interdental GS was present in 73% of the sites, and it was more frequently observed in men, in the central incisor region, and when facial GS was present. Multilevel logistic regression revealed a statistically significant association between the presence of GS and KTW, BT measured at 3 mm apical to the bone crest, and tooth type. This information can be used to recognize common periodontal phenotypical patterns associated with specific features of great clinical significance. [ABSTRACT FROM AUTHOR]

Mucogingival deformities around implants are frequent findings in clinical practice and often present as inadequate keratinized tissue and insufficient mucosal thickness. Phenotype modification therapy can increase peri-implant mucosal thickness and the amount of keratinized mucosa, improving the long-term clinical outcomes of implants. The free gingival graft (FGG) is considered the gold standard to increase keratinized mucosa; however, FGGs on the lingual aspects of implants are less predictable due to technique sensitivity and often present with insufficient gains in tissue thickness due to a limited blood supply. The semilunar lingualized apically positioned flap (SLAP) with subperiosteal tunnel connective tissue graft (CTG) can increase both peri-implant mucosal thickness and keratinized mucosal width circumferentially. SLAP consists of one full-thickness, semilunar incision within the keratinized mucosa and buccal to the implant, as well as two vertical releasing incisions mesial and distal to the implant, extending lingually into the alveolar mucosa. The tissue is apically positioned lingual to the implant and sutured in place, creating buccal space for a CTG via buccal subperiosteal tunneling. SLAP is a minimally invasive and predictable approach for improving the peri-implant mucosal phenotype. This case report demonstrates gains in peri-implant mucosal thickness and the amount of keratinized mucosa over a 10-month period utilizing SLAP with subepithelial CTG. [ABSTRACT FROM AUTHOR]

Healing outcomes of periodontal and implant-related regenerative procedures are closely related to wound stability, which is partially determined by biomechanical properties and behaviors of oral mucosal tissues. Studies on soft tissue behavior under biomechanical forces in oral regeneration models are scarce. Thus, this review aims to (1) contrast the microstructural differences between the attached gingiva (AM) and lining (LM) mucosa; (2) evaluate biomechanical behaviors of the two mucosal types; and (3) relate residual flap tension to the prevalence of wound opening after regenerative procedures. Compositional and structural differences between the AM and LM explain their biomechanical property differences. Wound destabilizers, including tissue recoil stemming from its viscoelastic property, muscle pull, and inflammatory edema (created after the flap-releasing procedure for primary wound closure) interfere with wound stability. Residual flap tension < 0.05 N is a prerequisite for sustained wound closure. Tissues under stress can exert negative cellular changes, resulting in necrosis and wound dehiscence. Biomechanical properties and the variations between AM and LM dictate the degree of wound stability. Efforts should be made to reduce the negative impact of the potential destabilizers to optimize wound stability. [ABSTRACT FROM AUTHOR]

The present study aimed to use CBCT to compare the influence of White and Black ethnicity on gingival and bone thickness. A total of 84 individuals of both genders, aged between 18 and 59 years old, were divided into Black (BG; n = 42) and White (WG; n = 42) groups and were analyzed from June 2020 to April 2021. The gingival thickness (GT) and buccal bone plate thickness (BBPT) were measured using CBCT in all maxillary anterior teeth. Mann-Whitney, t test, chi-square, Pearson correlation, and Spearman correlation were used for comparisons and correlations with a 5% significance level. Black individuals had mean GT (1.45 ± 0.29 mm) and BBPT (1.07 ± 0.21 mm) significantly thicker (gingival: P < .0001; bone: P = .0002) than White individuals (1.17 ± 0.28 mm and 0.91 ± 0.17 mm, respectively). The variables presented greater values for men. A positive correlation between the BBPT and GT was found in two teeth in the WG (left and right central incisors) and one tooth in the BG (left canine). Moreover, a correlation between BBPT and GT immediately below the alveolar bone crest (0 mm) was found in four teeth in the WG (left and right lateral and central incisors) and the BG (left and right canine, left lateral and central incisors). Black race was shown to significantly influence the GT and BBPT, with Black patients presenting thicker structures than White patients. [ABSTRACT FROM AUTHOR]

The primary aim of this study was to evaluate the efficacy of alveolar ridge preservation (ARP) therapy compared with unassisted socket healing (USH) in attenuating interproximal soft tissue atrophy. Adult patients who underwent maxillary single-tooth extraction with or without ARP therapy were included. Surface scans were obtained and CBCT was performed to digitally assess interproximal soft tissue height changes and measure facial bone thickness (FBT), respectively. Logistic regression models were conducted to investigate the individual effect of demographic and clinical variables. Ninety -six subjects (USH = 49; ARP = 47) constituted the study population. Linear soft tissue assessments revealed a significant reduction of the interproximal soft tissue over time within and between groups (P < .0001). ARP therapy significantly attenuated interproximal soft tissue height reduction compared to USH: -2.0 ± 0.9 mm mesially for USH vs -1.0 ± 0.5 mm mesially for ARP; -1.9 ± 0.7 mm distally for USH vs -1.1 ± 0.5 mm distally for ARP (P < .0001). Thin (< 1 mm) facial bone thickness (FBT) upon extraction was associated with greater interproximal soft tissue atrophy compared to thick FBT (> 1 mm), independent of the treatment received (P < .0001). Nevertheless, ARP therapy resulted in better preservation of interproximal soft tissue height, especially in thin bone phenotype, by a factor of 2 for the mesial site (+1.3 mm) and by a factor of 1.6 for the distal site (+0.9 mm). This study demonstrated that ARP therapy largely attenuates interproximal soft tissue dimensional reduction after maxillary single-tooth extraction compared to USH. [ABSTRACT FROM AUTHOR]

Purpose: To examine the behavior and function of human gingival fibroblasts growing on healing abutments with or without laser-textured topography. Materials and Methods: Human primary gingival connective tissue fibroblasts were cultured on healing abutments with machined or laser-textured (Laser-Lok, BioHorizons) surfaces. Cellular and molecular responses were evaluated by a variety of tests, including cell density assay (WST-1), fluorescence microscopy, real-time quantitative reverse-transcription polymerase chain reaction (qRT-PCR), and detachment tests. Results: The machined surface showed monodirectional traces and scratches from milling, whereas the laser-textured surface showed a distinct morphology consisting of monodirectional mesoscale channels (15-µm pitch) and woven oblique microridges formed within the channels. There were no differences in initial fibroblast attachment, subsequent fibroblast proliferation, or collagen production between the machined and laser-textured surfaces. Fibroblasts growing on a laser-textured surface were found to spread in one direction along the mesochannels, while cells growing on machined surfaces tended to spread randomly. Fibroblasts on laser-textured surfaces were 1.8 times more resistant to detachment than those on machined surfaces. An adhesive glycoprotein (fibronectin) and transmembrane adhesion linker gene (integrin ß-1) were upregulated on laser-textured surfaces. Conclusions: The increased fibroblast retention, uniform growth, and increased transcription of cell adhesion proteins compellingly explain the enhanced tissue-level response to laser-created and hybrid-textured titanium surfaces. These results provide a cellular and molecular rationale for the tissue reaction to this unique surface; in addition, they support its extended use, from implants and healing abutments to diverse prosthetic components where enhanced soft tissue responses would be desirable. [ABSTRACT FROM AUTHOR]

This case series investigated the effect of a combination therapy utilizing connective tissue graft (CTG) in the treatment of periodontal regeneration of mandibular Class III/IV furcation involvement (FI). Six patients diagnosed with periodontitis stage III or IV (grade A to C), presenting with Class III or IV FI, were treated with fibroblast growth factor-2 and carbonate apatite in combination with CTG. The following clinical parameters were evaluated at baseline and after 6, 12, and 18 months: periodontal probing depth, clinical attachment level, furcation invasion, radiographic vertical defect depth, and gingival phenotype. Significant improvements in clinical parameters were observed in all treated FI sites. Four Class III defects and one Class IV defect obtained complete closure, and one Class IV defect was improved to Class I. This case series showed the potential of administering combination regenerative therapy for changing the prognosis of hopeless teeth with severe furcation defects. [ABSTRACT FROM AUTHOR]

Objectives: This study compared the effects of leukocyte platelet-rich fibrin (L-PRF) and advanced platelet-rich fibrin (A-PRF) on patients' quality of life and the healing of palatal wounds after free gingival graft harvesting. Method and materials: After free gingival graft harvesting, palatal donor sites of 36 patients were assigned to one of three groups: L-PRF group, A-PRF group, or palatal stent + periodontal pack group (control group). Wound healing was evaluated by H2O2 test. Pain was evaluated by visual analog scale and number of analgesics consumed. For patient quality of life, the Oral Health Impact Profile-14 (OHIP-14) questionnaire was utilized. Results: Complete epithelialization was higher in the control group on day 7 than in the test groups (P < .05). Complete epithelialization was achieved in all groups 14 days postoperatively. Visual analog scale scores for pain and the number of analgesic tablets consumed were similar in all groups (P > .05). OHIP-14 total scores were similar in all study groups at 7 days postoperatively (P > .05). OHIP-14 total and physical pain score was lower in the L-PRF group than the A-PRF group at 14 days postoperatively (P < .05). Conclusion: Aside from the slight superiority of L-PRF over A-PRF, it can be concluded that both PRF procedures have similar effects on palatal wound healing and quality of life. [ABSTRACT FROM AUTHOR]

Purpose: This prospective study evaluated the marginal bone level and periodontal parameters 6 years after placement of a convergent transmucosal neck implant. Materials and Methods: In total, 71 implants were placed in 60 patients. Of these, 52 implants were placed with a flapless technique and with the convergent neck exposed by 1 mm (early and delayed placement), while 19 implants were placed immediately after extraction (immediate placement). At least 3 months after insertion, customized abutments were applied and provisional resin crowns were cemented, while being careful to prevent any tissue compression. After 3 weeks, definitive metal-ceramic crowns were designed with the finish line at the soft tissue level and free from any compression. The implant survival rate at 6 years, marginal bone level changes (ΔMBL, mm), and Pink Esthetic Score (PES) were evaluated. Gingival phenotype was determined before the implant surgeries (thin/thick). A three-level hierarchical model was examined with a random intercept and random slope on follow-up time at the patient level and a random intercept at the implant level. Results: In all, 57 patients with 67 implants reached the 6-year point; 3 patients (5.0%) dropped out. The implant survival rate was 100%. ΔMBL from baseline to 24 months was 0.58 mm (95% CI: 0.48, 0.68), while ΔMBL from 24 to 72 months was 0.33 mm (95% CI: 0.19, 0.47). PES improved steadily from 6 to 48 months (+0.96; 95% CI: 0.71, 1.20), with overall stability at 72 months. No correlation between MBL and PES was observed. A significant association was found between thick gingival phenotype and less MBL variation. Greater implant diameter offered more MBL stability after 3 years but resulted in lower PES values. Conclusions: The use of convergent transmucosal neck implants placed with a flapless transmucosal approach with the crown margin positioned at the gingival level preserved marginal bone and guided gingival morphology for up to 72 months. The gingival phenotype was the parameter that most affected the soft and hard tissues. In the long term, implant placement timing was not related to MBL. [ABSTRACT FROM AUTHOR]

Peripheral giant cell granulomas (PGCGs) are benign oral cavity tumors, reactive in nature, caused by local trauma or irritation. A 51-year-old woman presented with a soft tissue lesion related to an implant at site 36 (FDI numbering system). An excisional biopsy was completed, and the soft tissue mass was diagnosed as a PGCG. The biopsy led to a lack of keratinized tissue and vestibular depth around the implant site. After the initial healing phase, a free gingival graft was completed. Then, following soft tissue maturation, the cement-retained implant-supported prosthesis was converted into a screwretained implant-supported prosthesis that was easily accessible. With a combined periodontal and restorative approach, the KT increased, adequate vestibular depth was achieved, and there was no recurrence of the PGCG. [ABSTRACT FROM AUTHOR]

Purpose: To study the degree of accuracy in gingival shade matching of undergraduate students using a computer application. Materials and Methods: In total, 76 undergraduate dental students' gingival shade-selection abilities were evaluated using an in-house developed computer application. A total of 15 intraoral gingival photographs and 21 pink gingival color porcelain samples were used. The environmental conditions were standardized, and no time limit was set for answering in the computer application. Results: Fourteen gingival color samples (66.6%) were not useful for representing the studied gingival shades. Not all natural gingival colors studied were represented within the 50.50% acceptability limits of the pink samples. There were no statistically significant differences between men and women in terms of "hit" percentages. The highest correlation coefficient (in absolute value) was for the L* coordinate (the darker the gingiva in the picture, the higher the hit rate for choosing the "ideal" shade tab); however, none of the linear correlation coefficients were statistically significant. Conclusions: Not all colors provided in the pink ceramic system were useful for subjective gingival selection. There were no statistically significant differences between male and female dental students in gingival color perception. The L* coordinate was the only one that influenced the correct perception of gingival color by dental students, and it did so more in women than in men. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the biocompatibility of silver nanoparticle (AgNP)-doped Ti-6Al-4V surfaces by evaluating the viability and proliferation rate of human gingival fibroblasts (HGFs)--as the dominant cells of peri-implant soft tissues-- seeded on the modified surfaces. Materials and Methods: AgNPs (sizes 8 nm and 30 nm) were incorporated onto Ti-6Al-4V specimen surfaces via electrochemical deposition, using colloid silver dispersions with increasing AgNP concentrations of 100 ppm, 200 ppm, and 300 ppm. One control and six experimental groups were included in the study: (1) control (Ti-6Al- 4V), (2) 8 nm/100 ppm, (3) 8 nm/200 ppm, (4) 8 nm/300 ppm, (5) 30 nm/100 ppm, (6) 30 nm/200 ppm, and (7) 30 nm/300 ppm. HGF cell primary cultures were isolated from periodontally healthy donor patients and cultured in direct contact with the group specimens for 24 and 72 hours. The cytotoxicity of AgNP-doped Ti-6Al-4V specimens toward HGF was assessed by the MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) and BrdU (5-bromo-2'-deoxyuridine) assay tests. Calcein AM and ethidium homodimer (EthD-1) fluorescent stains were used to determine the live and dead cells. The morphology and attachment properties of the HGFs were determined via scanning electron microscopy (SEM). Results: Energy dispersive x-ray (EDX) analysis confirmed the presence of AgNPs on the specimens. The MTT test revealed that AgNPs of both sizes and all concentrations presented a decreased cellular metabolic activity compared to the control discs. All concentrations of both sizes of AgNPs affected the cell proliferation rate compared to the control group, as revealed by the BrdU assay. Overall, cytotoxicity of the modified Ti-6Al-4V surfaces depended on cell exposure time. Observation via confocal microscopy confirmed the results of the MTT and BrdU assay tests. Specifically, most cells remained alive throughout the 72-hour culture period. SEM images revealed that adjacent cells form bonds with each other, creating confluent layers of conjugated cells. Conclusions: The findings of the present study indicate that Ti-6Al-4V surfaces modified with 8 nm and 30 nm AgNPs at concentrations of 100 ppm, 200 ppm, and 300 ppm do not produce any serious cytotoxicity toward HGFs. The initial arrest of the HGF proliferation rate recovered at 72 hours. These results on the antibacterial activity against common periodontal pathogens, in combination with the results found in a previous study by the same research group, suggest that AgNP-doped Ti-6Al-4V surfaces are potential candidates for use in implant abutments for preventing peri-implant diseases. [ABSTRACT FROM AUTHOR]

Objective: Currently, there is no established treatment protocol to treat interdental papillary loss. This research aimed to evaluate the outcomes of interdental papillary reconstruction using minimally invasive surgery, with injectable hyaluronic acid gel. Method and materials: Seventeen patients were included, each with five sites of class 1 papillary recession (40 sites in the maxilla and 45 sites in the mandible). Subperiosteal tunneling was performed through a horizontal incision made apical to the base of the papilla without penetrating it. The free gingival sulcus was sealed by 000 retraction cord. A total of 0.2 to 0.6 mL hyaluronic acid was injected gradually. The incision was sutured with poly-glycolic sutures. Treated sites underwent clinical and digital evaluation at three follow-up time points (1 month, 3 months, and 6 months). Results: The interdental papillary defect height in the maxillary sites significantly reduced by 60%, 66%, and 42% at 1,3, and 6 months, respectively. In mandibular sites, the reduction was 54%, 55%, and 40% at the same follow-up time points. Regarding interdental papillary defect surface area in the maxilla, the reduction was 65%, 71%, and 45% at 1, 3, and 6 months. In the mandible, a reduction of 60%, 64%, and 48% was noticed at the same time points. Regarding patients' pain level score, during the day of surgery, 16 patients reported pain; the average pain score out of 10 was 3.94, and 11 patients (64.7%) needed to take analgesics. The pain generally subsided in the following days. At the day of treatment, 12 out of the 17 patients (70.6%) reported mild difficulty in speaking and eating. No complication, hypersensitivity, or allergy was noted in any patient. Conclusion: Subperiosteal tunneling with hyaluronic acid injection demonstrates clinical improvements in papilla height and papillary recession surface area reduction after 3 months of follow-up, with reduction in improvement after 6 months. Clinical significance: Adjunctive use of hyaluronic acid injection with minimally invasive surgery in interdental papillary management may improve clinical and esthetic outcomes. [ABSTRACT FROM AUTHOR]

The aim of this study was to present a periodontal plastic surgery approach to treat gingival recessions (GRs) and correct mandibular incisor mucogingival conditions and deformities. Isolated deep GRs (≥ 3 mm) in the mandibular incisors (n = 24 teeth) were treated: 66.6% of sites were recession types 2 or 3, and 58.3% of teeth were malpositioned. Recessions were treated using free mucogingival grafts (FMGs) harvested from the buccal aspect of donor teeth with altered passive eruption or healthy periodontal support, with < 3 mm between the cementoenamel junction and the buccal alveolar crest. Clinical parameters (GR, clinical attachment level, interproximal papilla tip location, keratinized tissue, vestibule depth) and root coverage esthetic score were evaluated at 9 months. FMG significantly reduced GR (P < .001) and increased keratinized tissue (P < .001) without loss of vestibule depth (P > .05). Mean root coverage was 94.37% ± 10.60%, mean residual GR was 0.08 ± 0.65 mm, and the mean root coverage esthetic score was 8.9 ± 1.24. Recession types 2/3 showed significant interproximal clinical attachment gain (P < .05). The interproximal papilla was significantly augmented at sites with papilla loss (P < .001). No clinical attachment loss (P = .346) was detected at donor sites. These results suggest that FMG is a promising root coverage approach for recession types 1, 2, and 3, correcting mucogingival conditions and deformities and reconstructing the interproximal papilla. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the periodontal responses of subgingival proximal margins elevated using different restorative materials. A total of 120 proximal cavities with dentin/cementum gingival margins were elevated using one of four materials (resin-modified glass ionomer, glass hybrid, flowable bulk-fill resin composite, or bioactive ionic resin) and completed with the same overlaying resin composite. At 2 weeks (baseline), 6 months, 1 year, and 2 years postrestoration, periodontal parameters and the radiographic distance between the restoration margin and bone crest were evaluated. Appropriate statistical analyses were performed. The values of all periodontal parameters increased with time, although only the increases in Plaque Index and probing depth within each material group were statistically significant. There were no statistically significant differences in any of the periodontal parameters between the different materials within the same evaluation period, nor between different time points or material groups in the radiographic distances. Both glass ionomer--based and resin-based materials were periodontally safe as subgingival open sandwich restorations. [ABSTRACT FROM AUTHOR]

Objective: Mucogingival surgery involving tissue grafts is commonly employed for cosmetic procedures like root coverage, and is increasingly applied in implant therapy to modulate peri-implant soft tissues and enhance implant survival. These procedures involve harvesting autologous connective or epithelial connective tissue, often from the palate or tuber maxillae. However, this can cause patient morbidity due to postoperative pain. Substitute materials, including animal-derived and xenografts, have been developed but lack qualities of autologous grafts. Method and materials: To address postoperative discomfort, a novel technique, named "palatal shield," using composite resin stabilized on adjacent teeth's palatal surface is proposed as an aid to donor site healing after mucogingival procedures. Two cases are reported where this technique was successfully applied. The first case involves a 53-year-old woman undergoing free gingival graft surgery for peri-implant treatment. The second case features a 58-year-old man receiving subepithelial connective tissue graft surgery for root sensitivity. Results: Ten days post surgery, both patients reported excellent postoperative comfort. The technique's effectiveness is highlighted in these cases, demonstrating its applicability in various surgical cases involving free gingival graft or connective tissue graft harvesting. Conclusion: The proposed "palatal shield" technique offers several advantages, including enhanced patient comfort, ease of application, and cost-effectiveness, making it a promising addition to mucogingival surgical procedures. [ABSTRACT FROM AUTHOR]

Objectives: Inflammatory disorders including periodontitis have been investigated for their impact on systemic inflammation and bone health. The present study was conducted with an aim to evaluate impact of control of periodontal inflammation through subgingival instrumentation on serum interleukin 6 and serum C-terminal telopeptide of type I collagen (CTX) in premenopausal females with stage II and III periodontitis. Method and materials: In this single-arm prospective study, periodontal parameters, serum interleukin 6, serum CTX, and hematologic parameters (total leukocyte count, differential leukocyte count, platelet count, mean platelet volume, and platelet distribution width) were assessed at baseline. Subgingival instrumentation was done, and oral hygiene instructions were given. At week 4, professional plaque control was performed, and oral hygiene instructions were reinforced. Serum and hematologic parameters were reassessed at 8 weeks after subgingival instrumentation, in individuals meeting the clinical endpoints (ie, bleeding on probing < 10%). Results: There was significant reduction in serum interleukin 6 of 0.168 ± 0.164 pg/mL (P = .000), and serum CTX of 17.459 ± 4.363 pg/mL (P = .000) at 8 weeks after subgingival instrumentation. There was significant decrease in eosinophil count (P = .018) and mean platelet volume (P = .016) at 8 weeks after subgingival instrumentation; however, no significant change was found in other hematologic parameters. Conclusion: Following subgingival instrumentation, biomarkers of both systemic inflammation (interleukin 6) and bone turnover (CTX) were observed to reduce significantly. This finding hints towards a positive impact of periodontal intervention on bone health. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this retrospective study was to assess the short- to mid-term restorative and periodontal outcome of deep margin elevation (DME) performed using resin composite. Materials and Methods: Twenty-eight teeth treated with DME and indirect adhesive restorations were followed-up for a mean of 25.4 months (minimum: 12 months). Clinical and radiographic examination assessed the adaptation of the DME material and indirect restorations, presence of recurrent caries or discoloration, periodontal health at DME and non-DME sites, and periapical health. Results: The overall success rate was 96.6%. One tooth showed signs and symptoms of apical pathology after 34 months following DME. No caries, discoloration, or periodontal pockets were detected in any of the treated teeth. DME had no detrimental effect on the gingival/periodontal health or plaque accumulation. There was no correlation between the distance from the DME material to the marginal bone level and pocket depth, gingival inflammation, and plaque accumulation (p > 0.05). Conclusion: Deep margin elevation might be considered a safe procedure for teeth with deep subgingival proximal caries in the short- and mid-term. [ABSTRACT FROM AUTHOR]

Objectives: Microneedling and injectable platelet-rich fibrin (i-PRF) have been proposed as relatively less invasive alternatives to surgical procedures for augmentation of thin periodontal phenotype. The present study was conducted to evaluate the effect of microneedling and i-PRF alone on gingival thickness in thin periodontal phenotype individuals. Method and materials: Systemically healthy individuals with thin periodontal phenotype in mandibular anterior teeth (n = 21) were treated with microneedling on one side and i-PRF on the contralateral side. Assessment of gingival thickness, keratinized tissue width, and periodontal parameters was done at baseline, and at 1, 3, and 6 months. Results: In intergroup comparison, a statistically significant increase in gingival thickness was observed with microneedling as compared to i-PRF at 6 months (P < .02). Intragroup comparison from baseline to 6 months showed a statistically significant increase in gingival thickness within both the groups: microneedling from 0.78 ± 0.12 mm to 1.00 ± 0.14 mm (P < .000), and i-PRF from 0.77 ± 0.10 mm to 0.93 ± 0.12 mm (P < .000). Intragroup comparison showed a statistically significant increase in keratinized tissue width in the microneedling group (P < .000). A statistically significant decrease in periodontal parameters was observed on intragroup comparison (P < .000). Conclusion: Considering the higher gain in gingival thickness and the added advantage of eliminating need for autologous blood withdrawal, microneedling is potentially better than i-PRF for phenotype modification in thin periodontal phenotype individuals. [ABSTRACT FROM AUTHOR]

Recurrent benign gingival lesions occurring in the anterior dentition are clinical dilemmas. While complete removal of such lesions is required to prevent recurrence, this can result in a poor esthetic outcome. Relative to this conundrum, this report discusses the diagnosis, psychologic management, and clinical treatment of two patients with recurring lesions on the facial gingiva of the mandibular and maxillary incisors, respectively. Patient A, a 55-year-old woman, presented with a recurrent peripheral ossifying fibroma (POF); Patient B, a 76-year-old man, presented with a recurrent pyogenic granuloma (PG). Both patients underwent multiple procedures and were ultimately treated without lesion recurrence. The efficacious surgical treatment of recurrent gingival lesions like POF and PG requires an aggressive approach involving lesion removal of the lesion as well as a 1.0- to 2.0-mm margin of normal tissue, underlying alveolar bone, and associated periodontal ligament (PDL). The rationale for this approach stresses the potential periodontal and esthetic ramifications that were considered. In summary, when recurrent benign gingival lesions are localized to the anterior part of the mouth, the approach to their surgical removal should be modified to minimize the extent of gingival recession and other potential esthetic issues. [ABSTRACT FROM AUTHOR]

Although connective tissue grafts (CTGs) have been found to increase gingival thickness and reduce facial gingival recession in immediate implant placement and provisionalization (IIPP), they are associated with significant loss of buccal bone thickness. This loss is thought to be related to the preparation of the facial CTG recipient site. This technical report presents a modified dual-zone therapeutic concept in which the bone zone is grafted with bone graft and the tissue zone is grafted with tuberosity CTG without elevation of a facial partial- or full-thickness envelope. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the alveolar sealing performance between free gingival graft (FGG) and porcine collagen membrane (MS) and qualitatively assess patient-centered outcomes via a visual analog scale. Method and materials: Eighteen patients were randomly divided into control (FGG) and test (MS) groups. After extraction, all the alveoli were filled with bovine bone grafts (small granules) and sealed. Follow-up was during the immediate postoperative period and after 3, 7, 15, 30, 60, 90, and 120 days. After 180 days, before implant placement, tissue samples were obtained for histologic analysis. The epithelial tissues were morphometrically measured for each sample. Qualitative information on the patient's perception of the treatment was collected after 7 days. Results: A faster healing was observed for the MS group. After 60 days, all the sites from the MS were partially healed, in contrast with only five from the FGG. The histologic results after 120 days showed for the FGG group a predominant acute inflammatory process, whereas chronic processes were observed for the MSgroup. The mean epithelial heights found for the FGG and MS were 535.69 pm and 495.33 pm, respectively (P = .54). The intragroup analysis showed significant variance among the data (P<.001) for both groups. The qualitative result showed statistically more significative comfort for the MS group (P < .05). Conclusion: Within the limitations of the study, both techniques effectively promote alveolar sealing. However, the visual analog scale result was superior and more signiffcant for the MS group, with faster wound healing and lower discomfort. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to evaluate the effect of injectable platelet-rich fibrin (i-PRF) on gingival thickness and gingival recession in individuals with thin periodontal phenotypes. Method and materials: In this prospective study, i-PRF was applied via a semisurgical method to augment 53 tooth regions with thin periodontal phenotypes. In order to ensure that sufficient blood clot formed on the side of the gingiva facing the bone and that i-PRF reached the area, a minimal incision was made with the help of a scalpel in the apical region of the relevant region, and the periosteum was elevated with a microsurgical instrument. To ensure sustained exposure to angiogenetic growth factors and enhance the histoconductive properties, i-PRF injection was applied to the relevant areas in foursessions at 10-dayintervals. Results: An increase in gingival thickness was achieved in 92.5% of the areas treated with i-PRF, and the desired gingival thickness (0.8 mm) was achieved in 44.9% of these areas. In addition, significant reductions in the amount of recession were observed in 83.3% of the 12 gingival recession areas (P= .005). Moreover, complete coverage was achieved in 60% of these regions. Conclusion: With the new i-PRF semisurgical method, it was shown that gingival thickness can be increased in tooth regions with thin gingiva, andthat areas of gingival recession can be covered. Further comprehensive studies are needed to fully understand the role of i-PRF in enhancing angiogenesis and the histoconductive properties of this fully autogenous blood concentrate. [ABSTRACT FROM AUTHOR]

Background: Oral leiomyomatous hamartoma (OLH) corresponds to an abnormal, benign and disorganized overgrowth of mature smooth muscle tissue, which can develop in any site where this tissue is found in healthy conditions. The present systematic review aimed to analyze the clinicopathological characteristics of OLH. Materials and methods: The protocol of this study was constructed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and was registered in the Open Science Framework (OSF): OSF.IO/BMPUX. Five electronic databases were used to identify studies for this systematic review: PubMed, Web of Science, Dentistry & Oral Science Source, Scopus and ScienceDirect, from January 15th, 1945 to January 10th, 2024. The Joanna Briggs Institute (JBI) tool was used to assess the risk of bias and the quality of the included reports and case series. Results: A comprehensive search yielded 5,562 articles, of which 55 met the inclusion criteria. The total number of subjects studied in the included investigations was sixty-six. The subjects' ages varied from newborns to 61 years, with a mean age ± standard deviation of 71.23 ± 123.01 months. 50.7% were males and 49.3% were females. Most lesions presented normochromic color (24.24%), pedunculated base (31.81%), firm consistency (22.72%), with an average size of 1.20 cm, present on the dorsum of the tongue (31.81%) or anterior part of the alveolar border of the maxilla (30.30%). Treatment was carried out by surgical excision (78.46%) and half of the studies report that there were no recurrences. Conclusions: The cases described in the medical-dental literature provide valuable information to date on the clinicopathologic and immunohistochemical profile of OLH. Although it is a rare lesion, it should be considered as part of the differential diagnosis in newborns, infants, children and young adults with lingual and/or maxillary masses present in the midline. [ABSTRACT FROM AUTHOR]

The goal of this study was to develop a new poly(methyl methacrylate) (PMMA)-based conjugate with enhanced mucoadhesive features for gingiva. Five MMA-based conjugates with varying amounts of hydroxyethyl maleimide (HEM) and poly(ethylene glycol) (PEG) were synthesized and characterized using infrared spectroscopy and proton nuclear magnetic resonance. Quantification of attached HEM and PEG was performed using assay kits and established protocols. Mucoadhesiveness was tested through rheological measurements, retention time, and tensile strength studies. Results showed successful unification of MMA with HEM and PEG, with varying degrees of modification and no toxic effects. Dynamic viscosity was enhanced up to 13-fold for MMA-100Mal, decreasing incrementally for MMA-75Mal, MMA-50Mal, MMA-25Mal, and MMA-0Mal. Retention time improved up to 120-fold for MMA-100Mal, decreasing to 37.5-fold for MMA-0Mal. Mucoadhesiveness followed the order: MMA-100Mal > MMA-75Mal > MMA-50Mal > MMA-25Mal > MMA-0Mal. In conclusion, the novel modification of MMA with increased mucoadhesive features to buccal gingiva suggests its potential as a long-term total denture base material, paving the way for more patient-friendly prostheses. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: To evaluate the interaction between the NLRP3 inflammasome and superoxide dismutase-2 (SOD2) to provide an insight into the complex host response in periodontitis patients with type 2 diabetes mellitus (T2DM), who have an inherent upregulation of inflammatory cytokines and reactive oxygen species (ROS). Methods: Gingival tissues were collected from 51 patients divided into three groups: group 1, systemically and periodontally healthy; group 2, systemically healthy with periodontitis; and group 3, periodontitis with T2DM. Immunohistochemistry was performed to evaluate the expression of the NLRP3 inflammasome and SOD2 in terms of mean percentage, intensity and staining intensity distribution (SID). Results: The mean percentage levels of NLRP3 and SOD2 expression were statistically significantly higher in group 3 (49.16 ± 6.45% and 48.22 ± 11.66%, respectively) when compared to groups 2 and 1 (p < 0.001). While the groups with periodontitis with or without T2DM had statistically significant differences in these variables, the highest expression was found in the periodontitis patient group with T2DM (p < 0.001). NLRP3 and SOD2 mean percentages were positively correlated in groups 1 and 2 but were negatively correlated in group 3. Conclusion: NLRP3 inflammasome is significantly upregulated in periodontitis patients with T2DM. The negative correlation between SOD2 and NLRP3 in periodontitis patients with T2DM probably indicates insufficient endogenous SOD2 to effectively counteract the excessive oxidative burden and inflammatory state, thereby compounding periodontal destruction in cohorts with T2DM. Further, NLRP3 and SOD2 can be used as biomarkers of periodontal disease progression in periodontitis cohorts modified by DM. [ABSTRACT FROM AUTHOR]

Periodontitis is a chronic inflammatory disease caused by dysbiotic biofilms and destructive host immune responses. Extracellular vesicles (EVs) are circulating nanoparticles released by microbes and host cells involved in cell‐to‐cell communication, found in body biofluids, such as saliva and gingival crevicular fluid (GCF). EVs are mainly involved in cell‐to‐cell communication, and may hold promise for diagnostic and therapeutic purposes. Periodontal research has examined the potential involvement of bacterial‐ and host‐cell‐derived EVs in disease pathogenesis, diagnosis, and therapy, but data remains scarce on immune cell‐ or microbial‐derived EVs. In this narrative review, we first provide an overview of the role of microbial and host‐derived EVs on disease pathogenesis. Recent studies reveal that Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans‐derived outer membrane vesicles (OMVs) can activate inflammatory cytokine release in host cells, while M1 macrophage EVs may contribute to bone loss. Additionally, we summarised current in vitro and pre‐clinical research on the utilisation of immune cell and microbial‐derived EVs as potential therapeutic tools in the context of periodontal treatment. Studies indicate that EVs from M2 macrophages and dendritic cells promote bone regeneration in animal models. While bacterial EVs remain underexplored for periodontal therapy, preliminary research suggests that P. gingivalis OMVs hold promise as vaccine candidates. Finally, we acknowledge the current limitations present in the field of translating immune cell derived EVs and microbial derived EVs in periodontology. It is concluded that microbial and host immune cell‐derived EVs have a role in periodontitis pathogenesis and hence may be useful for studying disease pathophysiology, and as diagnostic and treatment monitoring biomarkers. [ABSTRACT FROM AUTHOR]

Aims: Despite the established use of palatal tissue grafts for mucogingival procedures, there are no studies on the effect of extraoral storage time on graft outcomes. This prospective split‐mouth randomized experimental clinical trial aimed to assess whether gingival graft extraoral storage time affects graft healing. Methods: Standardized grafts were harvested from the palate and stored extraorally for 2 (Control) or 40 (Test) minutes before being placed at recipient beds. Intraoral scans, clinical photographs, and tissue blood perfusion were obtained preoperatively, postoperatively, and at follow‐up visits (Days 2 (PO2), 3 (PO3), 7 (PO7), and 14 (PO14)). Healing Score Index (HSI) and wound fluid (WF) biomarkers (angiogenin, IL‐6, IL‐8 (CXCL8), IL‐33, VEGF‐A, and ENA‐78 (CXCL5)) were also assessed. Results: Twenty‐three participants completed all study visits. Extraoral storage time was 2.3 ± 1.1 min and 42.8 ± 3.4 min for C and T grafts, respectively (p <.0001). Recipient beds remained open for 21.4 ± 1.7 min. No graft underwent necrosis or failed to heal by PO14. Minimal volumetric changes were observed, without significant intergroup differences (p ≥.11). Graft perfusion initially decreased post‐harvesting before peaking on PO7 for both C and T grafts, with no significant intergroup differences (p ≥.14). HSI values progressively increased, with no significant intergroup differences (p ≥.22). WF analysis revealed detectable levels for all biomarkers tested, without significant intergroup differences (p ≥.23). Conclusion: Extraoral storage time of 40 min has neither statistically significant nor clinically discernible effects on autologous graft revascularization, early healing, or survival, as determined by physiological, wound healing, and molecular parameters. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to evaluate the effectiveness of a chitosan‐based dressing (CD) in achieving early wound healing and hemostasis at palatal donor sites in patients undergoing free gingival graft (FGG) surgery. Methods: Thirty‐two patients requiring FGG were treated in this randomized controlled clinical trial. Complete epithelialization (CE) and color match (CM) at donor sites were assessed by a blinded examiner on postoperative days 7, 14, 21, and 28. Donor sites were compressed for 2 min with wet gauze (WG) alone in control group (CG) or WG + CD in test group (TG) immediately after graft harvesting, and immediate bleeding (IB) was recorded (yes/no). Delayed bleeding (DB) (for 1 week), and number of analgesic tablets consumed, and VAS scores for pain (for 2 weeks) were recorded by patient every day. Results: Twenty‐eight patients (14 in each group) were included in final analysis. The prevalence of CE (at weeks 2 and 3) and VAS scores for CM scores were higher in TG but the intergroup differences were statistically significant only for CM (at week 4). Number of patients exhibiting IB and DB was significantly fewer in the TG (p <.05). Although average pain scores and analgesic consumption were higher in TG up to 5 days, differences between two groups were not statistically significant at any time point. Conclusion: Our data suggests that the application of CD increased re‐epithelialization and accelerated wound healing process, although it did not reach statistical significance. Moreover, CD was found to significantly reduce bleeding complications, but it did not decrease the pain levels. [ABSTRACT FROM AUTHOR]

Background: Direct and indirect associations have been identified among health literacy, health behavior, and health status. Thus, we aimed to investigate the influence of oral health literacy and behaviors in parents on their children's oral health status. Moreover, we aimed to analyze the mentioned mediating effects through oral health behavior management. Methods: Oral health information of 1,102 preschool children aged 3 to 6 years was collected from five primary schools in Jinjiang District, Chengdu City, Sichuan Province, China. The decay-missing-filled teeth (DMFT) index and soft scale plaque index (PI) were used by professional dentists aided by school teachers to assess caries and periodontal health among the children. Simultaneously, we conducted a questionnaire-based survey among the parents to determine their oral health literacy and health behavior and their children's oral health behavior. The probit model, instrumental variables, and mediation effect model were used to evaluate the association of parents' oral health literacy and behavior with their children's oral health status. Results: The DFMT index was 1.58 among the children, with zero caries in 646 (58.6%) children. The PI was 0.68, with zero gum disease in 517 (46.9%). The univariate analysis suggested that the parents' health literacy and behavior were correlated with their children's oral health status (P < 0.01). Parents' oral health behavior significantly affected their children's oral health status. Simultaneously, a stronger correlation was observed upon using parents' health literacy as an instrumental variable to assess the endogeneity, indicating endogeneity problems. Parents' health-related behaviors exerted a mediating effect on children's oral health, with parents helping children brush their teeth demonstrating the strongest effect. Conclusion: Parents' oral health-related behaviors can affect their children's oral health status. We recommend enhancing parents' oral health literacy to improve children's oral health status. [ABSTRACT FROM AUTHOR]

Background: This study aimed to elucidate the pathogenesis of idiopathic gingival fibromatosis (IGF). Methods: Human gingival fibroblasts (hGFs) were isolated from patients with IGF and periodontitis. Differential gene expression in the hGFs was analyzed using RNA sequencing. Extracellular matrix-related gene expression in the hGFs was analyzed. The effect of specific protein (SP)1 inhibitor or recombinant human transglutaminase 2 (rh-TGM2) on biglycan (BGN) expression in hGFs was also determined. Results: RNA sequencing showed that TGM2 expression was downregulated and BGN mRNA expression was upregulated in patients with IGF relative to periodontitis. rh-TGM2 stimulation of hGFs in patients with IGF significantly reduced BGN expression. SP1 inhibitors downregulated BGN expression in the hGFs. Conclusion: BGN upregulation via SP1 causes TGM2 downregulation in gingival fibroblasts in IGF. [ABSTRACT FROM AUTHOR]

Background: This study investigates the dose-response relationship of acetylcholine (ACh) on healthy human gingival blood flow (GBF). Understanding this dose-response relationship contributes to studying vasodilatory mechanisms in various pathological conditions. Methods: The study involved 22 young healthy men (21 - 32 years) to investigate the dose-response relationship of ACh on GBF. Semi-circular wells were created on the labial surface of the upper right second incisor (FDI #12) and upper left first incisor (FDI #21), including the gingival sulcus, for the application of drugs. ACh-chloride solutions at 0.1, 1, and 10 mg/mL were administered to the gingival sulcus of tooth FDI #12 with a Hamilton syringe. Physiological saline was applied on the contralateral side to FDI #21 as a control. The GBF was measured non-invasively by the laser speckle contrast imaging method in four 1mm high adjacent regions: coronal, midway1, midway2, and apical, and was expressed in a laser speckle perfusion unit (LSPU). After the baseline blood flow recording, ACh doses were applied sequentially, with washout periods in between. Data were statistically analyzed using a linear mixed model. Results: The GBF did not change on the saline site throughout the experiment. The GBF was significantly higher at the coronal region after all ACh doses (baseline: 218±31 LSPU, and 227±38 LSPU p < 0.05, 239±40 LSPU p < 0.001, 291±54 LSPU p < 0.001, respectively) compared to the saline. It was also elevated following 1 and 10 mg/mL at the midway1 (245±48 LSPU, p < 0.05, 293±65 LSPU p < 0.001). At midway2 and apical, only the 10 mg/mL dose was effective (285±71 LSPU, p < 0.001; 302±82 LSPU, p < 0.001). Conclusions: Our findings suggest a dose-dependent vasodilation to ACh, emphasizing its role in human gingival microcirculation. Only the 10 mg/mL ACh could evoke remote vasodilation 3 mm from the application. The described method could facilitate the investigation of endothelium-dependent vasodilation in disorders affecting microcirculation, such as periodontitis or diabetes. [ABSTRACT FROM AUTHOR]

The post-mortem interval (PMI) is the time elapsed between the death of an individual and its forensic examination. It is a crucial information for judicial authorities, but current techniques still cannot establish a precise time interval. Novel approaches are therefore required. Recently, gingival tissue has emerged as interesting for forensic analysis thanks to the protection offered by lips to this tissue, limiting the influence of environmental factors. It is also easily accessible, and its sampling is minimally invasive even in the presence of rigor mortis. Moreover, the expression of HIF-1α, a master mediator of the hypoxic environment, has been described in gingival samples at different post-mortem (PM) times. We have hypothesized that the time-dependent post-mortem expression of HIF-1α could serve as a biomarker to more accurately predict the PMI. Our analyses were performed in an animal model, the mouse, where environment can be precisely controlled. Therewith, gingival tissue morphology was evaluated through histochemical staining and HIF-1α expression was analyzed by qPCR, western blots and immunofluorescence at different post-mortem times (0h to 100h). Our results showed (a) a global post-mortem stability of gingival tissue (b) a rapid increase in HIF-1α mRNA expression in the short post-mortem times followed by a slow decrease in transcript expression until 100h PM (c) an expression of the HIF- 1α protein and its degradation products, that follows the mRNA pattern (d) the presence of HIF-1α protein in the epithelial and connective layers of the tissue, with signal accumulation in both gingival strata until at least 32h post-mortem. This pilot study thus validated the mouse and the gingival tissue as models for post-mortem analyses, as well as for studying the fate of proteins such as HIF-1α. Transferring these approaches to human subjects may provide a more accurate estimate of PMI. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Key points Plain Language Summary Orthodontic treatment in adults with thin periodontal phenotype presents challenges such as lengthy treatment time and increased risk for gingival recessions. In this case, surgically facilitated orthodontic treatment (SFOT) was proposed to accelerate orthodontic tooth movement while modifying the periodontal phenotype.An orthodontic patient was referred for periodontal evaluation of lower anterior teeth, which presented a thin gingival phenotype and bone dehiscence. SFOT was performed on the mandible using particulate allograft combined with platelet rich fibrin (PRF) and collagen membrane to augment soft and hard tissue, thereby preventing future recessions, while accelerating the treatment times.Six‐month and 3‐year follow‐ups confirmed radiographic bone fill, absence of gingival recession and thick band of keratinized gingiva. SFOT also resulted in a shorter treatment time where desired tooth movements were achieved within 6 months with periodontal stability.SFOT provided clinical benefits by accelerating orthodontic movement, improving periodontal phenotype, preventing the displacement of teeth beyond the alveolar housing and minimizing the risk for development of dehiscences and gingival recessions. Orthodontic movements can create recessions and dehiscence in thin periodontal phenotypes. SFOT can help prevent bone dehiscence and creates a thicker gingival phenotype while accelerating treatment time. Orthodontic movements can create recessions and dehiscence in thin periodontal phenotypes.SFOT can help prevent bone dehiscence and creates a thicker gingival phenotype while accelerating treatment time.Adults who face lengthy orthodontic treatments and have thin gums have risks of gum problems. Surgically facilitated orthodontic treatment (SFOT) can help by speeding up tooth movements and improving gum health and thickness.A patient with thin gums and lack of bone in the lower front teeth was evaluated. The SFOT procedure involved using a bone graft, healing factors, and a collagen membrane to strengthen the gums and bones. This approach aimed to prevent future gum problems and speed up orthodontic treatment.Follow‐ups at 6 months and 3 years after treatment showed good healing of the gums and bones, with no signs of gum recession and healthier, thicker gums. The desired tooth movements were achieved within 6 months, resulting in a shorter treatment time. The patient's gums remained stable throughout this period.SFOT offered significant clinical benefits, including faster tooth movement and improved gum health. It also helped prevent teeth from moving out of place and minimized the risk of gum recession and bone issues. This approach can be a valuable option for adults with thin gums undergoing orthodontic treatment. [ABSTRACT FROM AUTHOR]

Background: The objective was to evaluate the level of neutrophil extracellular traps (NETs) in patients with chronic kidney disease (CKD) and periodontitis, and to explore the relationship between NETs and both diseases. Methods: 63 CKD and 40 non-CKD participants were recruited and underwent periodontal examination, among which 35 early CKD patients underwent periodontal therapy. The concentrations of NETs were determined by dsDNA assay in gingival crevicular fluid (GCF) and plasma, and by flow cytometry or immunofluorescence assay in blood and gingival tissues. The correlations between NETs and clinical parameters were analyzed. The influence of periodontal therapy on periodontitis, CKD and NETs concentrations was also evaluated. Results: CKD patients had higher concentrations of NETs in plasma than non-CKD patients, and NETs concentrations were also increased in both GCF and plasma of patients with periodontitis than that of periodontally healthy patients. NETs concentrations were positively correlated with increased clinical parameters of CKD and periodontitis. The positive correlation between CKD and periodontitis was demonstrated. Moreover, periodontal therapy ameliorated periodontitis and CKD, and reduced NETs concentrations in GCF of patients. Conclusions: This study revealed that NETs might be a possible bridge between periodontitis and CKD, and suggested the potential target for therapy. [ABSTRACT FROM AUTHOR]

Background: Existing studies predominantly focused on the relationship between periodontitis and type 2 diabetes mellitus (T2DM), with limited data on the association between periodontitis and type 1 diabetes mellitus (T1DM). This study aimed to examine the impact of T1DM and periodontitis on the subgingival microbiome and levels of advanced glycation end-products (AGEs). Methods: Samples were collected from four groups: T1DM, periodontitis (P), T1DM with periodontitis (DP), and periodontally and systemically healthy controls (Control). Subgingival microbiome composition and AGE levels were assessed using 16S rRNA gene sequencing and enzyme-linked immunosorbent assay (ELISA), respectively. Correlations between clinical indexes, microbiome composition, and AGEs were analyzed using Spearman correlation coefficient. Results: Alpha and beta diversity analyses revealed significant differences in bacterial diversity between the DP group and other groups. Linear discriminant analysis effect size (LEfSe) analysis identified specific bacteria influencing each group: Acinetobacter, Leptotrichia, Raoultibacter, and Veillonella in the Control group; Tannerella, Porphyromonas, Filifactor, and Treponema in the P group; and Lactobacillales in T1DM individuals. Prevotella and Selenomonas were notably influential in the DP group. PICRUSt2 analysis showed pathways alterations were concentrated in cell motility, translation, cell growth and death and metabolism in the DP and P groups. Spearman correlation analysis indicated a positive correlation between AGEs and periodontitis or diabetes-related parameters and AGEs were positively correlated with Haemophilus and Arachnia. Conclusions: The findings suggested that the composition and function of the subgingival microbiome in the P group with or without T1DM were significantly different. Additionally, AGEs were involved in the development of periodontitis even in absence of hyperglycemia. [ABSTRACT FROM AUTHOR]

Objective: To analyze the clinicopathological and evolutionary profile of the main locations of oral squamous cell carcinoma (OSCC). Materials and Methods: This is a retrospective study on 133 patients treated for OSCC. The group was composed of 48 women and 85 men, with a mean age 63.9 ± 12.73 years. Most cases involved the lingual border of tongue (63), followed by the gingiva (36) and the floor of mouth (34). A comparative analysis was performed using multinomial regression. Results: There were significant differences regarding age, sex, tobacco and alcohol consumption, liver pathology, oral potentially malignant disorders, and bone and perineural invasion. In multivariate regression, tobacco consumption, and bone invasion remained significant. There were no significant differences in relation to prognosis. Conclusion: The location of OSCC is an important factor in the clinicopathological assessment of this neoplasm. The main locations of OSCC show differential etiopathogenic and clinicopathological aspects. Tobacco consumption has a great relevance in the floor of mouth; nonetheless, it is less important in the tongue border and the gum, which suggests other pathogenic factors. It is necessary to consider the anatomical location of OSCC in preventive protocols, with the aim of reducing its high mortality. [ABSTRACT FROM AUTHOR]

Objective: To investigate the production of leucine‐rich α‐2‐glycoprotein‐1 (LRG1) in periodontitis patients and its effectiveness as a new diagnostic marker for periodontitis. Subjects and Methods: In vitro experiments were conducted to analyze LRG1 mRNA expression in human gingival epithelial cells and fibroblasts via quantitative real‐time PCR. In vivo experiments were conducted to analyze LRG1 localization in periodontitis patients. The correlation between the serum LRG1 levels and alveolar bone resorption in the mouse periodontitis model was also investigated. Results: A positive correlation existed between the periodontal inflamed surface area and serum LRG1 levels (Spearman's rank correlation coefficient: 0.60). LRG1 mRNA expression in human gingival epithelial cells and fibroblasts was upregulated by Porphyromonas gingivalis stimulation or tumor necrosis factor‐α stimulation. Interleukin‐6 in human gingival epithelial cells and fibroblasts induced the production of LRG1 and transforming growth factor‐β. LRG1 levels in the periodontal tissue and serum in the periodontitis model were higher than those in control mice. LRG1 local administration resulted in alveolar bone resorption, whereas the administration of interleukin‐6R antibody inhibited bone resorption. Conclusions: LRG1 levels in serum and periodontal tissue are upregulated in periodontitis and are implicated in periodontal tissue destruction through interleukin‐6 production. [ABSTRACT FROM AUTHOR]

Objective: To characterize the distribution of macrophages, neutrophils, NK cells, and blood vessels in peri‐implantitis compared to healthy aged gingiva samples. Materials and Methods: This observational study included eight gingival samples from peri‐implantitis and eight from periodontally healthy individuals. By immunofluorescence were identified neutrophils, NK cells, macrophages, and their pro‐inflammatory or pro‐healing phenotypes, and blood vessels. Two ROIs were designated as zone 1, connective tissue closest to the epithelium and zone 2, connective tissue over 200 microns from the rete ridges. Immune cells and vascular structures were quantified and characterized according to their distribution in both zones. Results: Two peri‐implantitis zones were characterized by unique macrophage phenotypes and blood vessel architecture. Blood vessels were larger in zone 2 in peri‐implantitis. A greater number of NK cells and macrophages were found in peri‐implantitis compared to healthy aged samples. A higher presence of pro‐inflammatory macrophages was found in zone 1 compared to zone 2. A similar proportion of pro‐inflammatory and pro‐healing macrophages were found in zone 2. Conclusion: A specific distribution for pro‐inflammatory macrophages and vascular architecture is observed in peri‐implantitis. TNF‐α colocalizes with macrophages in the connective tissue near rete ridges. NK cells are more abundant in peri‐implantitis than in healthy samples. [ABSTRACT FROM AUTHOR]

The local gingival tissue environment with homeostasis and tissue‐destructive events of periodontitis demonstrates major changes in histological features and biology of the oral/sulcular epithelium, fibroblasts, vascular cells, inflammatory cell infiltration, and alveolar bone. Objective: This study used an experimental periodontitis model to detail the gingival transcriptome related to cell death processes of pyroptosis, necroptosis, ferroptosis, and cuproptosis. Materials and Methods: Healthy Macaca mulatta primates stratified by age, ≤3 years (young), 7–12 years (adolescent), 12–15 years (adult), and 17–23 years (aged), provided gingival tissue biopsies for microarray analysis focused on 257 genes representative of the four cell death processes and bacterial plaque samples for 16S rRNA gene analysis. Results: Age differences in the profiles of gene expression in healthy tissues were noted for cuproptosis, ferroptosis, necroptosis, and pyroptosis. Major differences were then observed with disease initiation, progression, and resolution also related to the age of the animals. Distinct bacterial families/consortia of species were significantly related to the gene expression differences for the cell death pathways. Conclusions: These results emphasized age‐associated differences in the gingival tissue molecular response to changes in the quality and quantity of bacteria accumulating with the disease process reflected in regulated cell death pathways that are both physiological and pathophysiological. [ABSTRACT FROM AUTHOR]

Lithium disilicate (LS) ceramic emerges as a compelling option for customized implant abutments. However, ensuring its safety and reliability requires clarification on key aspects, notably its impact on inflammation and potential for cell adhesion. This study delves into these considerations, examining the influence of LS ceramic on cytokine release and the transcriptional profile of human gingival fibroblasts (hGFs) in direct contact with various LS surfaces. hGFs were cultured on LS disks featuring three distinct surfaces (unpolished, polished, and polished glaze), while titanium disks served as reference material and cells cultured directly on plates as controls. The surface of the disks was analyzed using a scanning electron microscope. The cell metabolism was analyzed by MTT test, cytokine release by MAGPIX and the expression of genes related to cell adhesion was evaluated by qPCR. The disks exhibited similar topography with smooth surfaces, except for the unpolished LS disks, which had an irregular surface. Contact with LS surfaces did not substantially reduce cell metabolism. Moreover, it generally decreased cytokine release compared to controls, particularly pro-inflammatory mediators like IL-1β, IL-6, and TNF-α. Significantly increased expression of genes related to cell adhesion to LS was observed, comparable to titanium, the gold standard material for implant abutments. Significance: This study unveils that LS ceramic not only fails to trigger pro-inflammatory cytokine release, but also significantly enhances gene expression associated with cell adhesion. These mechanisms are closely linked to gene pathways such as PTK2 , SRC , MAPK1 , and transcription factors ELK-1 and MYC. In summary, the findings underscore LS ceramic's potential as a biocompatible material for implant abutments, shedding light on its favorable inflammatory response and enhanced cell adhesion properties. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between interleukin‐8 (IL‐8) levels in gingival crevicular fluid (GCF) and total oral fluid (TOF) and the responsiveness to steps 1 and 2 of periodontal therapy. Materials and Methods: One‐hundred and fifty‐nine patients affected by periodontitis received steps 1 and 2 of periodontal therapy. At baseline, TOF and GCF samples were collected and analysed for IL‐8 (Il‐8TOF/IL‐8GCF) using flow cytometry. Therapy outcomes were relative proportions of residual periodontal pockets (PPD%), pocket closure (PC) rates and pocket probing depth (PPD) reductions; these were associated with IL‐8TOF/IL‐8GCF. Results: High IL‐8TOF was significantly associated with higher residual PPD% (p = 0.044) and lower PPD reduction compared to low IL‐8TOF (high 0.79 ± 1.20 mm vs. low 1.20 ± 1.20 mm, p < 0.001) in non‐smokers, while in smokers high IL‐8GCF was related to lower PPD reduction (high 0.62 ± 1.22 mm vs. low 0.84 ± 1.12 mm, p = 0.009). Furthermore, high baseline IL‐8TOF was significantly associated with poorer PC rates compared to medium and low concentrations in both non‐smokers (high 41% vs. medium 55% vs. low 58%, p < 0.001) and smokers (high 34% vs. medium 44% vs. low 46%, p < 0.001). Conclusion: High IL‐8 concentrations at baseline had a significant impact on residual PPD%, PC rates and PPD reduction. The findings suggest that, especially in non‐smokers, baseline IL‐8 levels collected from the TOF could serve as a component in the estimation of responsiveness to steps 1 and 2 of periodontal therapy. [ABSTRACT FROM AUTHOR]

Aim: To describe the microbiological composition of subgingival dental plaque and molecular profile of gingival crevicular fluid (GCF) of periodontal furcation‐involved defects. Materials and Methods: Fifty‐seven participants with periodontitis contributed with a degree II–III furcation involvement (FI), a non‐furcation (NF) periodontal defect and a periodontally healthy site (HS). Subgingival plaque was analysed by sequencing the V3–V4 region of the 16S rRNA gene, and a multiplex bead immunoassay was carried out to estimate the GCF levels of 18 GCF biomarkers. Aiming to explore inherent patterns and the intrinsic structure of data, an AI‐clustering method was also applied. Results: In total, 171 subgingival plaque and 84 GCF samples were analysed. Four microbiome clusters were identified and associated with FI, NF and HS. A reduced aerobic microbiota (p =.01) was detected in FI compared with NF; IL‐6, MMP‐3, MMP‐8, BMP‐2, SOST, EGF and TIMP‐1 levels were increased in the GCF of FI compared with NF. Conclusions: This is the first study to profile periodontal furcation defects from a microbiological and inflammatory standpoint using conventional and AI‐based analyses. A reduced aerobic microbial biofilm and an increase of several inflammatory, connective tissue degradation and repair markers were detected compared with other periodontal defects. [ABSTRACT FROM AUTHOR]

Young patients often times are poor candidates for implant-supported restorations due to ongoing jawbone development. This case report describes a viable restorative option for a 16-yearold patient who had a large cleft defect and a hopeless prognosis for the right lateral incisor. The clinician utilized a combination of a fixed bonded ceramic restoration to replace tooth No. 7 and direct composite resin, including pink composite resin, to restore the symmetry and gingival level of tooth No. 8. This conservative approach allowed for an esthetic outcome while providing the patient a stable and functional restoration. [ABSTRACT FROM AUTHOR]

There are a number of protocols that the clinician has to consider when providing implant treatment. Immediate implant placement has its place in implant dentistry and should be considered following a strict case selection. This article discusses the factors that should be taken into account when planning and providing immediate implant placements, with an emphasis on achieving a good outcome. The evidence base is discussed with a description of the surgical stages involved and subsequent restoration. Cases to illustrate this technique and its limitations are presented. CPD/Clinical Relevance: Principles for single tooth implant replacement in the anterior maxilla, where aesthetic expectations are high are relevant to clinicians. [ABSTRACT FROM AUTHOR]

The aim of this study was to characterize the clinicopathological features and prognostic factors of T1/2 size (<4 cm) gingival squamous cell carcinoma (SCC) and to verify the impact of bone invasion. This was a single-centre, retrospective cohort study involving 206 patients with gingival SCC (maxilla or mandible), treated between 2000 and 2020. The patients were divided into three subgroups based on tumour size and bone invasion. The 5-year overall survival (OS) and disease-free survival (DFS) were 80.6% and 67.6%, respectively. Histological differentiation, advanced T stage, positive resection margin, bone invasion, and postoperative adjuvant therapy were associated with a poor prognosis (P < 0.05). Multivariate Cox analysis indicated that only histological differentiation (hazard ratio (HR) 2.68, P = 0.007) and bone invasion (HR 2.08, P = 0.036) were significantly associated with DFS. Bone invasion was observed in 145 (70.4%) patients, of whom 43 (20.9%) had a T1/2 size tumour. The subgroup with bone invasion and T1/2 size showed significantly worse OS and DFS when compared to the subgroup without bone invasion and similar or worse survival when compared to the subgroup with bone invasion and T3/T4 size. Histological differentiation and bone invasion were poor prognostic factors for gingival SCC, even in cases with small-sized tumours. For suspected bone invasion in small-sized tumours, an adequate bone margin is necessary and postoperative adjunctive therapy needs to be considered. [ABSTRACT FROM AUTHOR]

Aims: This study aims to evaluate the periodontal status and its changes among Japanese older adults over a 10‐year period. Methods and results: A total of 206 dentate older adults aged 70 years who completely participated in 10 years of oral examination were included. The community periodontal index (CPI) was used to assess the gingival and periodontal pocket status, while the loss of attachment (LA) scoring system was used to report the extensive LA. A higher score in CPI (Code 3 and Code 4) and more extensive attachment loss were found in a majority of participants. During follow‐up evaluation, mean number of sextants with CPI code 4 remained stable, while CPI code 3 significantly decreased particularly in male participants. Whereas, sextants without attachment loss significantly decreased on average. The mean number of missing sextants significantly increased from 1.1 to 1.9, and 5.8% of subjects had all sextants excluded in the follow‐up. Conclusion: This study indicated that majority of the older people experienced severe periodontal disease and this condition remained stable during 10‐year period. Additionally, the incidence of tooth loss increased as individuals aged. Regular oral care and maintenance are highly recommended for older population. [ABSTRACT FROM AUTHOR]

Background: Halitosis in children implies psychosocial repercussions. Risk factors associated with this condition are unclear, and detection methods are inaccurate. Aim: To quantify the levels of sulfur‐like compounds in children with asthma and healthy children from a novel validated assay, and to establish the risk factors related to halitosis. Design: One hundred and twenty‐eight individuals (63 healthy and 65 asthmatic) from 3 to 17 years of age were tested using a passive colorimetric sensor to measure the levels of sulfur‐like compounds in breath and saliva. Information was collected on oral hygiene habits, gingival and dental health, breathing type, and dental malocclusion. Results: The mean values of hydrogen sulfide were 4.0 ± 6.8 and 19.7 ± 12.2 ppbv (parts per billion in volume) in the control and asthmatic groups, respectively (p <.001). The presence of higher concentrations of sulfur compounds was significantly associated (p <.05) with the presence of gingival inflammation, tongue coating, dental plaque, mouth breathing, hypomineralization, age, tongue brushing, and the use of dental floss. Conclusion: The level of sulfur in breath and saliva was significantly higher in patients with asthma. These results can serve as a precedent to raise awareness among paediatricians and parents about oral hygiene care in children and adolescents. [ABSTRACT FROM AUTHOR]

Two-dimensional (2D) culture models and animal experiments have been widely used to study the pathogenesis of periodontal and peri-implant diseases and to test new treatment approaches. However, neither of them can reproduce the complexity of human periodontal tissues, making the development of a successful 3D oral mucosal model a necessity. The soft-tissue attachment formed around a tooth or an implant function like a biologic seal, protecting the deeper tissues from bacterial infection. The aim of this review is to explore the advancements made so far in the biofabrication of a junctional epithelium around a tooth-like or an implant insert in vitro. This review focuses on the origin of cells and the variety of extracellular components and biomaterials that have been used for the biofabrication of 3D oral mucosa models. The existing 3D models recapitulate soft-tissue attachment around implant abutments and hydroxyapatite discs. Hereby, the qualitative and quantitative assessments performed for evidencing the soft-tissue attachment are critically reviewed. In perspective, the design of sophisticated 3D models should work together for oral immunology and microbiology biofilms to accurately reproduce periodontal and peri-implant diseases. [ABSTRACT FROM AUTHOR]