Early periodontal wound healing after chlorhexidine rinsing: a randomized clinical trial.

OBJECTIVES: This single-center randomized, parallel design, clinical trial with a 2-week follow-up involved patients affected by periodontitis undergoing periodontal surgery. The aim was to evaluate periodontal surgical wound healing with the use of chlorhexidine-based mouth rinses versus an untreated control group. MATERIALS AND METHODS: Periodontal surgery was performed following a standardized protocol. Patients were randomly prescribed i) chlorhexidine (CHX) + anti-discoloration system (ADS) + hyaluronic acid (HA), ii) CHX + ADS or iii) no treatment (control group). Plaque score, gingival inflammation, and Early Healing Index (EHI), assessing the degree of wound closure and the presence of fibrin and necrosis, were evaluated at 3, 7 and 14 days after surgery. RESULTS: In total, 33 patients were enrolled. Patients were comparable at baseline for all measured clinical parameters. At 3-days wound healing was significantly improved in all patients treated with CHX + ADS-based mouth rinses with a lower EHI score at the interdental papillae compared with control group (p < 0.01). CHX + ADS + HA group presented improved healing across all time points in terms of EHI, plaque containment, and gingival inflammation when compared to control group (p < 0.01). CONCLUSIONS: The usage of CHX-ADS following periodontal surgery improved early wound healing, reduced plaque accumulation and gingival inflammation. During the early post-operative period the adjunct of HA further improved soft tissue closure. CLINICAL RELEVANCE: This study aims at evaluating the response of gingival tissues to mouth rinsing with chlorhexidine and anti-discoloration system (CHX + ADS) or CHX + ADS + hyaluronic acid (CHX + ADS + HA) versus no rinse in terms of healing of the periodontal surgical wound. CHX + ADS mouth rinses enhanced early soft tissue closure after periodontal surgery and contributed to the reduction in plaque accumulation and gingival inflammation. The adjunct of HA may be beneficial especially in the early post-operative period. CHX + ADS administration following periodontal surgery may improve soft tissue healing in the first two post-operative weeks.

Inflammatory and bone remodelling related biomarkers following periodontal transplantation of the tissue engineered biocomplex.

OBJECTIVES: To assess gingival crevicular fluid (GCF) levels of inflammatory and bone remodelling related biomarkers following transplantation of a tissue-engineered biocomplex into intrabony defects at several time-points over 12-months. MATERIALS AND METHODS: Group-A (n = 9) received the Minimal Access Flap (MAF) surgical technique combined with a biocomplex of autologous clinical-grade alveolar bone-marrow mesenchymal stem cells in collagen scaffolds enriched with an autologous fibrin/platelet lysate (aFPL). Group-B (n = 10) received the MAF surgery, with collagen scaffolds enriched with aFPL and Group-C (n = 8) received the MAF surgery alone. GCF was collected from the osseous defects of subjects via paper strips/30 sec at baseline, 6-weeks, 3-, 6-, 9-, 12-months post-surgery. Levels of inflammatory and bone remodelling-related biomarkers in GCF were determined by ELISA. RESULTS: Group-A demonstrated significantly higher GCF levels of BMP-7 at 6-9 months than baseline, with gradually decreasing levels of pro-inflammatory and pro-osteoclastogenic markers (TNF-α, RANKL) over the study-period; and an overall decrease in the RANKL/OPG ratio at 9-12 months than baseline (all p < 0.001). In comparison, only modest interim changes were observed in Groups-B and -C. CONCLUSIONS: At the protein level, the approach of MAF and biocomplex transplantation provided greater tissue regeneration potential as cell-based therapy appeared to modulate inflammation and bone remodelling in residual periodontal defects. CLINICAL RELEVANCE: Transplantation of a tissue engineered construct into periodontal intrabony defects demonstrated a biochemical pattern for inflammatory control and tissue regeneration over 12-months compared to the control treatments. Understanding the biological healing events of stem cell transplantation may facilitate the design of novel treatment strategies. CLINICAL DATABASE REGISTRATION: ClinicalTrials.gov ID: NCT02449005.

Bibliometric Network Analysis and Visualization of Research Trends in Gingivectomy.

Background: Gingivectomy has been the preferred method since the findings in 1884. It evolved from "blind" subgingival scaling to "the excision of the soft tissue". The use of these techniques is no longer mandatory in clinical situations; therefore, researchers have searched for numerous publications that have been registered regarding gingivectomy. This research aims to fill the niche area by assessing more about gingivectomy and it's trend among the periodontology topic of discussion. Methods: Descriptive and analytical observation by evaluating the result of the VOS viewer mapping and calculation throughout the bibliographic data from publications obtained from SCOPUS in July 2022. Results: There are 660 publications from six types of publication. Related keywords are compiled and visualized by network mapping. There is a significant gap among the contributing countries in the number of documents and number of citations per journal. However, a minimal gap is seen in other objectives, such as authors, journals, and institutions on their contribution towards the publication of gingivectomy topics. Conclusion: A total of 660 of 1914 articles were included in the analysis after the filtering process, and these articles were cited 5910 times, with an average of 9 citations per article.

High-Density Dermal Matrix for Soft Tissue Augmentation Using a Matrix Tissue Graph Technique-A Comprehensive Multicenter Analysis of 20 Implants: A 1-Year Follow-Up Retrospective Study.

Background: In this multicenter case series analysis, the authors present successful instances of 20 single-screw-retained and implant-supported prosthetic rehabilitation samples. Methods: A high-density heterologous dermal matrix (Derma® Osteobiol by Tecnoss, Torino, Italy) was employed with a specific technique named the matrix tissue graft (MTG) in all these cases characterized by an inadequate initial supra-crestal tissue height (thin if 1 mm or medium if 2 mm) to enhance the peri-implant soft tissues both vertically and horizontally. Results: The implants were deemed successful in all cases, yielding a success proportion of 100% (one-sided 97.5% confidence interval = 83.2-100%). The buccal and lingual gains were, respectively, 2.2 ± 0.38 mm (range 1.7-3.22 mm) and 0.83 ± 0.33 mm (range 0.1-1.5 mm). These measurements were calculated as the maximum distance between two superimposed .stl file models (derived from two different IOS devices) scanned before implant placement and 1 year after dermal matrix healing. Conclusions: An outstanding vertical and horizontal gain was obtained using this heterologous derma matrix placed above the bone crest and surrounding the dental implants.

Successful Management of a Tooth With an Endodontic-Periodontal Lesion Using a Bone Graft.

As periodontal and endodontic tissues have a close association, they come into close touch and have a lot of possible places for communication. In a clinical setting, this correlation promotes infection spread and results in the typical endo-perio lesion appearance. Because the two tissues are in close touch with one another, managing such lesions can be difficult. The success of treatment depends on a thorough examination and careful planning, with the sole focus on repair and regeneration. In these situations, bone graft materials with such characteristics have demonstrated encouraging outcomes. The treatment outcome along with a follow-up for a case of an endo-perio lesion with furcation involvement is shown in the accompanying case report. In treating such instances, a multidisciplinary approach is necessary, emphasizing regeneration.

Instructions for the use of L-PRF in different clinical indications.

Autologous platelet concentrates (APCs) have demonstrated clear benefits across various clinical applications, including alveolar ridge preservation, guided tissue regeneration, guided bone regeneration, sinus floor elevation (both lateral window approach and transcrestal technique), endodontic surgery, the treatment of medication-related osteonecrosis of the jaw bones, and periodontal plastic surgery. To ensure an optimal clinical outcome, clinicians must adhere strictly to the protocol to prepare the APCs and, especially follow evidence-based surgical guidelines, often simple but crucial, to minimize the likelihood of errors. The majority of clinical trials reported on second-generation APCs [the leukocyte- and platelet-rich fibrin (L-PRF) family, including its modifications (A-PRF, A-PRF+, CGF, T-PRF, H-PRF, etc.)]. These second-generation APCs offer additional benefits compared to the first-generation APCs, making them the preferred choice for the development of clinical recommendations. These recommendations have been formulated through a meticulous examination of the available clinical data and the clinical experience of the authors of this paper.

The Use of Titanium Pins for the Management and Fixation of Free Gingival Grafts and Apically Repositioned Flaps During Vestibuloplasty. A Technique Report.

INTRODUCTION: The presence of adequate keratinized mucosa (KM) around dental implants and natural dentition is pivotal for the long-term success of dental restorations. Despite various techniques to augment KM, challenges persist in achieving stable, keratinized, and adherent mucosa, especially in the context of significant muscle pull or compromised tissue conditions. This study introduces a novel application of titanium pins for the fixation of free gingival grafts (FGG) and apically repositioned flaps (APF) during vestibuloplasty, aiming to overcome important limitations associated with traditional suturing methods and shorten the treatment time and patient morbidity. METHODS: Three patients with insufficient KM width, presenting discomfort during oral hygiene and inflammation around implant restorations and natural teeth, underwent soft tissue augmentation using titanium pins traditionally used in guided bone regeneration (GBR) for the stabilization of FGGs and APFs. This method ensures intimate contact between the graft and the periosteum, facilitating proper graft perfusion and revascularization, minimizing shrinkage and the risk for necrosis of the graft. RESULTS: Postoperative follow-up revealed successful integration of the grafts, with minimal shrinkage and increased width and depth of KM. The use of titanium pins allowed for reliable fixation in challenging surgical sites, where traditional suturing methods were impractical due to the presence of extensive muscle pull and an unstable recipient bed. CONCLUSION: The application of titanium pins for the fixation of FGGs and APFs during vestibuloplasty provides a promising alternative to traditional suturing techniques, particularly in complex cases where the recipient bed is suboptimal for suturing. This method simplifies and shortens the procedure, offering a predictable outcome with increased mechanical stability and minimal shrinkage of the graft. Randomized clinical trials are recommended to further evaluate the efficacy of this technique.

Aumento de coroa clínica: reparação do desequilíbrio dentogengival com finalidade estética / Clinical crow augmentum: repair of the dentogengival imbalance with aesthetic purpose

O anseio por um sorriso harmônico tem se tornado cada vez maior, uma vez que muitos pacientes relatam desconforto ao sorrir, pois correlacionam a estética do sorriso a problemas de baixa autoestima e em alguns casos suscetibilidade a alterações psicossociais decorrente aos padrões estéticos impostos pela sociedade. O sorriso gengival é uma das grandes queixas relatadas por pacientes. A exposição excessiva de gengiva maxilar pode ser decorrente a fatores gengivais, ósseos, dentários e musculares. Dentre os tratamentos disponíveis para diminuir essa exposição, contamos com cirurgias periodontais, aplicação de toxina botulínica, tratamentos ortodônticos, cirurgia ortognática e reposicionamento labial. O tratamento adequado será definido de acordo com o fator etiológico de cada caso. Diante disso o objetivo do trabalho é realizar um relato de caso sobre aumento de coroa clínica estética. A paciente estava descontente com a exibição de uma grande quantidade gengival ao sorrir. Após estudos clínicos e de imagem o diagnóstico foi de erupção passiva alterada, tipo IB. O tratamento de escolha foi a gengivoplastia associada a remodelação óssea osteotomia e osteoplastia. O tratamento estético vai além de uma boa aparência, através deste trabalho, foi possível evidenciar impactos benéficos que o sorriso harmônico pode acarretar na vida do indivíduo, atendendo suas expectativas e a do cirurgião-dentista(AU)

The desire for a harmonic smile has become increasing, since many patients report discomfort when smiling, as they correlate smile aesthetics to problems of low self-esteem and in some cases susceptibility to psychosocial changes due to aesthetic standards imposed by society. Gummy smile is one of the major complaints reported by patients. Excessive exposure of the maxillary gingiva may be due to gingival, bone, dental and muscular factors. Among the treatments available to reduce this exposure, we have periodontal surgeries, botulinum toxin application, orthodontic treatments, orthognathic surgery and lip repositioning. The appropriate treatment will be defined according to the etiological factor of each case. Therefore, the objective of this work is to carry out a case report on aesthetic clinical crown augmentation. Patient discount with the display of a large amount of gingival when smiling. After clinical and imaging studies, the diagnosis was an altered passive eruption, type IB. The treatment of choice was gingivoplasty associated with bone remodeling, osteotomy and osteoplasty. Final comments and conclusions: The aesthetic treatment goes beyond a good appearance, through this work, it was possible to evidence beneficial impacts that the harmonic smile can have on the individual's life, meeting their expectations and that of the dentist(AU)

Assessment of Postoperative Edema in Different Bone Graft Cases in Vertical Defects in Periodontal Surgery: An Original Research.

Background: To replace missing periodontal tissues in vertical defects during periodontal surgery, bone graft materials are frequently used. A frequent occurrence that can affect healing outcomes is postoperative edema. The purpose of this study was to evaluate postoperative edema in various vertical bone graft defects following periodontal surgery. Materials and Methods: 50 participants were split into two groups for a prospective study: Group A received xenografts, whereas Group B received synthetic grafts. Up to 14 days after surgery, baseline and routine postoperative edema measurements were made. Edema levels in each group were compared using statistical analysis. Results: At all postoperative time points, Group A showed substantially more edema than Group B (P < 0.05). Furthermore, edema persisted longer in Group A than it did in Group B. Conclusion: In conclusion, the substance of the bone graft used in vertical defects during periodontal surgery affects postoperative edema. Compared to synthetic grafts, xenografts caused swelling to last longer and at higher levels. To maximize healing results, clinicians should take these findings into account when choosing graft materials.

Evaluating the Long-Term Outcomes of Periodontal Surgery vs. Non-Surgical Treatment in Aggressive Periodontitis.

Background: Aggressive periodontitis is a severe form of periodontal disease characterized by rapid tissue destruction and tooth loss. The optimal treatment approach for managing this condition remains a topic of debate. Materials and Methods: A retrospective cohort study was conducted, involving patients diagnosed with aggressive periodontitis who received either surgical or non-surgical treatment between 2010 and 2020. Clinical and radiographic data were collected at baseline and regular intervals over a 5-year follow-up period. Surgical interventions included flap surgery, guided tissue regeneration, and bone grafting, while non-surgical treatments comprised scaling and root planning with or without adjunctive antibiotics. The primary outcomes assessed included changes in probing depth, clinical attachment level, tooth loss, and patient-reported quality of life measures. Results: A total of 120 patients were included in the study, with 60 patients in each treatment group. The surgical group demonstrated significantly greater reductions in probing depth and gains in clinical attachment level compared to the non-surgical group (P < 0.05). Tooth loss was significantly lower in the surgical group over the 5 years (P < 0.01). Patient-reported outcomes also favored the surgical group, with improved oral health-related quality of life. However, the surgical group had a higher incidence of postoperative complications. Conclusion: This study suggests that periodontal surgery yields superior long-term outcomes in the management of aggressive periodontitis compared to non-surgical treatment.

Comparing the Clinical and Radiographic Outcomes of Two Different Surgical Approaches for Treating Infrabony Defects in Chronic Periodontitis Patients.

Background: Chronic periodontitis is a prevalent oral health issue, affecting a substantial portion of the population. Infrabony defects, characterized by bone loss around teeth, are a hallmark of this condition and require surgical intervention to prevent further damage and tooth loss. Two commonly used surgical approaches are open flap debridement (OFD) and guided tissue regeneration (GTR). Materials and Methods: This prospective cohort study included 60 patients with chronic periodontitis and infrabony defects. Patients were randomly assigned to either the OFD or GTR group. Clinical parameters, including probing depth (PD) and clinical attachment level (CAL), were recorded at baseline and at 6-month and 12-month follow-up appointments. Radiographic assessments were conducted using periapical radiographs. The primary outcome measures were changes in PD and CAL, while secondary outcomes included radiographic evidence of bone regeneration. Results: At the 6-month follow-up, the OFD group demonstrated an average reduction in PD of 2.4 mm (SD = 0.8) and an increase in CAL of 1.6 mm (SD = 0.5). In contrast, the GTR group showed a reduction in PD of 2.1 mm (SD = 0.7) and an increase in CAL of 1.9 mm (SD = 0.6). These differences were not statistically significant (P > 0.05). Radiographic analysis indicated a mean bone fill of 1.2 mm (SD = 0.4) in the OFD group and 1.4 mm (SD = 0.3) in the GTR group at 12 months, with no significant difference observed between the two groups (P > 0.05). Conclusion: In this study, both OFD and GTR approaches demonstrated comparable clinical and radiographic outcomes in the treatment of infrabony defects in chronic periodontitis patients.

Individualized digitally designed surgical template for guided soft tissue surgery in cases with severe gingival enlargement: A clinical application in hereditary gingival fibromatosis.

AIM: The purpose of this study was to present the use of computer-assisted periodontal surgery utilizing a novel surgical guide for cases with severe gingival enlargement through a clinical application in a patient with hereditary gingival fibromatosis. MATERIALS AND METHODS: The treatment plan included nonsurgical periodontal therapy, surgical periodontal treatment, and regular periodontal maintenance before the initiation of orthodontic treatment. Due to the increased soft tissue thickness, a surgical guide with a novel design was fabricated to facilitate the periodontal surgery since most of the patient's teeth were malpositioned and underexposed due to fibromatosis. For this purpose, the patient's intraoral scan was merged with a CBCT image in order to plan surgical excisions based on the anatomy of the teeth and the bone contour. RESULTS: The customized surgical guide facilitated the gingivectomy by controlling not only the shape of the initial incisions but also their orientation toward the level of the cementoenamel junction, improving the efficiency of the clinical time compared with freehand surgery and assisting in the verification of the final soft tissue shape, based on the treatment plan. CONCLUSION: Digital technology through the superimposition of multiple data sets can assist in the diagnosis and multidisciplinary management of cases with gingival fibromatosis. The proposed design of the surgical guide can facilitate soft tissue surgery based on the digital treatment plan, leading to more predictable management of the soft tissue, especially in patients with severe gingival enlargement, as in cases with hereditary gingival fibromatosis or drug-induced gingival overgrowth.

Braided silk sutures coated with photoreduced silver nanoparticles for eradicating Staphylococcus aureus and Streptococcus mutans infections.

BACKGROUND: Infections resulting from surgical procedures and wound closures continue to pose significant challenges in healthcare settings. To address this issue, the investigators have developed antibacterial non-resorbable braided silk sutures using in situ deposited silver nanoparticles (AgNPs) and investigated their efficacy in eradicating Staphylococcus aureus and Streptococcus mutans infections. METHODS: The braided silk sutures were modified through a simple and efficient in situ photoreduction method, resulting in the uniform distribution of AgNPs along the suture surface. The synthesized AgNPs were characterized using scanning electron microscopy (SEM), dynamic light scattering analysis (DLS) and Fourier Transform Infrared Spectroscopy analysis (FTIR) confirming their successful integration onto the silk sutures. The antibacterial activity of the nanoparticle coated sutures were compared and evaluated with non-coated braided silk sutures through in vitro assays against both S. aureus and S. mutans. RESULTS: The surface and cross-sectional analysis of the treated sutures revealed a uniform and homogeneous distribution of silver particles achieved through the photoreduction of silver solution. This observation confirms the successful coating of silver nanoparticles (AgNPs) on the sutures. The antimicrobial studies conducted, demonstrated significant reductions in bacterial colonies when exposed to the silver nanoparticle-coated sutures. Notably, the width of the inhibition zone surrounding the coated sutures remained consistently wide and stable for duration up to 7 days. This sustained and robust inhibitory effect against gram-positive bacteria, specifically S. aureus and S. mutans, serves as strong evidence of the antibacterial efficacy of the coated sutures. CONCLUSION: The coating of silk sutures with AgNPs provided a significant and effective antibacterial capacity to the surgical sutures, with this activity being sustained for a period of 7 days. This suggests that AgNPs-in situ photoreduction deposited sutures have the potential to effectively manage S. aureus and S. mutans infections.

Increased safety in periodontal surgery: Doppler ultrasound for detection of relevant palatal blood vessels-A proof-of-concept and cross-sectional study.

AIM: To evaluate the suitability of a Doppler ultrasound probe in detecting the greater palatine artery or its greater branches non-invasively. MATERIALS AND METHODS: The palatal mucosa of 108 participants (median age 34 years, 51 female) was systematically divided into transversal sectors, each aligning with the positions of the upper molars (M), premolars (P) and canine teeth (C), aiming to facilitate precise and consistent localization of the detected palatal blood vessel across different patients. Blood flow of the palatal blood vessels, presumably, was located by scanning the palatal vault bilaterally using an 8-MHz ultrasound probe linked to a transducer. The distance to the corresponding tooth was measured using a millimetre-scale periodontal probe. RESULTS: Within the regions of M2 to P1, the ultrasound transducer gave a delimitable acoustic pulse signal in 80%-98% of all measurements. The measured median distances between the determined position of the artery and the corresponding teeth ranged from 13 to 15 mm, with smaller distances in the anterior region. In several sectors, the distance was significantly higher for men (C: p = .048; P1: p = .041, M1: p < .01; M2: p = .034). CONCLUSIONS: Use of the Doppler ultrasound transducer might be a promising approach to non-invasively detect relevant palatine blood vessels preoperatively. It, therefore, might have the potential to reduce the risk of accidental injury during palatal surgery.

Vital root resection with radicular retrograde partial pulpotomy in furcation-involved maxillary molars in patients with periodontitis: Technique description and case series considering clinical and economic aspects.

AIM: Conventional root resection in periodontally compromised furcation-involved maxillary molars requires preceding endodontic treatment and is therefore associated with loss of tooth vitality, higher invasiveness, treatment time and costs, and the risk of endodontic complications. Vital root resection (VRR) could overcome these disadvantages while establishing stable periodontal and endodontic conditions. This case series aimed to introduce the concept of one-stage VRR with radicular retrograde partial pulpotomy (VRRretro). SUMMARY: Seven vital maxillary molars with residual probing pocket depths (PPD) ≥ 6 mm and furcation ≥ class 2 of five patients with stage III/IV periodontitis were treated with VRRretro using mineral trioxide aggregate. Teeth with residual through-and-through furcations were additionally tunnelled. Follow-up up to 2.5 years postoperatively during supportive periodontal care included full periodontal status, percussion and thermal sensitivity testing. Periapical radiographs were obtained to rule out possible periradicular radiolucencies. All seven treated molars were in-situ at an average of 26.84 ± 5.37 months postoperatively and were clinically and radiographically inconspicuous independent of tooth position, the resected root, the need for tunnelling and the restorative status. The mean PPD on the seven treated molars was 4.02 ± 0.85 mm (6-10 mm) preoperatively and 2.62 ± 0.42 mm (3-4 mm) at the last follow-up. Clinical attachment level and bleeding on probing could also be decreased. The teeth showed no mobility over time and furcations class 2 were reduced to class 1 while the tunnelled furcations were accessible with interdental brushes. All molars reacted negatively to percussion and positively to thermal sensitivity testing. KEY LEARNING POINTS: In carefully selected cases considering patient- and tooth-related factors, VRRretro could be a promising treatment option to establish stable periodontal and endodontic conditions in furcation-involved maxillary molars while preserving tooth vitality.

Management of interdental papillary defects using subperiosteal hyaluronic acid injection overlay technique: a prospective longitudinal clinical study.

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 (HA) gel. MATERIALS AND METHODS: Seventeen patients were included, each with five sites of class 1 papillary recession; (forty sites in the upper jaw and forty-five sites in the lower jaw). 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. After that a total of 0.2-0.6 mL HA was injected gradually. The incision was sutured with polyglycolic 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 upper jaw sites significantly reduced by 60%, 66%, and 42% at 1 month, 3 and 6 months, respectively. Also, in lower jaw sites, the reduction was of about 54%, 55%, and 40% at the same follow up time points. Regarding interdental papillary defect surface area in the upper jaw the reduction was about 65%, 71%, and 45% at 1 month, 3 and 6 months. In the lower jaw, a reduction of about 60%, 64%, and 48% was noticed at the same time points. Regarding patients' pain level score, during the day of surgery, sixteen patients reported pain, the average pain score out of 10 was 3.94, and eleven patients (64.7%) needed to take analgesics. The pain generally subsided in the following days. Also, at the day of the treatment twelve out of the seventeen patients (70.6%) reported mild difficulty in speaking and eating. No complication, hypersensitivity or allergy was noted in any patient. CONCLUSION: Subperiosteal tunneling with HA 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.

Orthodontic tooth movement after periodontal regeneration of intrabony defects.

The prevalence of intrabony defects in patients with advanced periodontitis stages III and IV is high. These patients usually need both periodontal treatment and orthodontic therapy, including tooth movement through bone defects, to improve masticatory function, aesthetics, and overall quality of life. Clinical practice guidelines recommend periodontal regenerative surgical interventions to resolve these defects and propose initiating orthodontic tooth movement (OTM) once periodontal therapy goals have been met. Surgical interventions using various regenerative technologies like barrier membranes and enamel matrix proteins, combined or not with bone replacement grafts, have proven effective in regenerating lost periodontal tissues. However, the combination of periodontal and orthodontic treatments requires consideration of how periodontal regenerative therapies influence OTM. Studies suggest that regenerated bone may differ in density, composition, vascularity, and cellular activity, potentially affecting the speed and efficiency of OTM, and potential root resorption of moved teeth. Understanding the sequence and timing of implementing OTM after regenerative periodontal interventions is crucial due to their interlinked processes of bone resorption and formation. This narrative review aims to uncover scientific evidence regarding these combined treatments, examining the impacts of different regenerative technologies on OTM and delineating their advantages, limitations, and best practices.

Current status of Er:YAG laser in periodontal surgery.

Lasers have numerous advantageous tissue interactions such as ablation or vaporization, hemostasis, bacterial killing, as well as biological effects, which induce various beneficial therapeutic effects and biological responses in the tissues. Thus, lasers are considered an effective and suitable device for treating a variety of inflammatory and infectious conditions of periodontal disease. Among various laser systems, the Er:YAG laser, which can be effectively and safely used in both soft and hard tissues with minimal thermal side effects, has been attracting much attention in periodontal therapy. This laser can effectively and precisely debride the diseased root surface including calculus removal, ablate diseased connective tissues within the bone defects, and stimulate the irradiated surrounding periodontal tissues during surgery, resulting in favorable wound healing as well as regeneration of periodontal tissues. The safe and effective performance of Er:YAG laser-assisted periodontal surgery has been reported with comparable and occasionally superior clinical outcomes compared to conventional surgery. This article explains the characteristics of the Er:YAG laser and introduces its applications in periodontal surgery including conventional flap surgery, regenerative surgery, and flapless surgery, based on scientific evidence from currently available basic and clinical studies as well as cases reports.

Exploring the Potential of Phytogenic Materials for Bone Regeneration: A Narrative Review of Current Advances and Future Directions.

In dentistry, bone regeneration in areas following tooth loss, the removal of a tumor or cyst, and craniofacial surgery can be accomplished by using bone grafts. Many biocompatible materials have been employed for bone regeneration in dentistry; however, all these bone graft materials come with various drawbacks. Therefore, there is a growing demand for natural, cost-effective, and biocompatible plant-based bone grafts. This review explores the emerging field of phytogenic elements in bone restoration and their specific applications in dentistry. The review focuses on key phytogenic compounds, such as algae-based and plant-based bone substitutes, delineating their roles in bone regeneration in dental bone defects. It also highlights the existing challenges associated with phytogenic grafts, such as limited bioavailability and high-dose toxicity. This calls for increased research into compatible, affordable carriers and a broader spectrum of studies to determine the most effective phytogenic solutions in dental regenerative medicine.

Efficacy of Topical Vitamin C Application on Healing After Gingival Depigmentation by Scalpel: A Case Series.

Every person expresses their blissful moments through a smile. The elegance of the smile depends majorly on the colour of the gingiva. One of the factors that determines the colour of the gingiva is the amount of melanin pigment in the gingival epithelium. The intensity of melanin pigmentation differs from one person to another, and it is prevalent among all ethnicities. Most people are aesthetically concerned and widely prefer pink gingiva, leading to a demand for gingival depigmentation. There are various suggested treatment modalities for gingival depigmentation, like scalpel, electrosurgery, LASER, cryosurgery, etc. However, the recurrence of pigmentation is common in the depigmentation procedure. The current study attempts to determine the post-operative healing of gingival tissues following split-thickness epithelial excision with and without topical application of Vitamin C (ascorbic acid).