Edgard S. El Chaar

Periodontal disease is a prevalent and chronic inflammatory condition increasingly recognized for its systemic implications beyond oral health. While traditionally confined to dentistry, recent evidence reveals strong associations between periodontitis and chronic systemic conditions such as cardiovascular disease, diabetes mellitus, rheumatoid arthritis, inflammatory bowel disease, Alzheimer's disease, and various cancers. Mechanistic studies have identified plausible biological pathways, including systemic dissemination of periodontal pathogens and immune mediators, which can exacerbate distant organ inflammation and dysfunction. Experimental models highlight how oral bacteria influence immune responses, disrupt gut and vascular homeostasis, and contribute to oncogenesis and autoimmunity. Notably, bidirectional relationships, such as those between periodontitis and diabetes, underscore the need for integrated care approaches. Effective periodontal therapy has demonstrated systemic benefits, including improved glycemic control and reduced inflammation. Given the mounting evidence, periodontal disease should be approached as a critical component of systemic health, necessitating interdisciplinary collaboration among healthcare providers to optimize patient outcomes and public health.

To evaluate its efficacy and predictability in immediate extraction sockets, this case series used demineralized bone matrix in a puttylike carrier (DBM putty) with and without mineralized bone chips. Each preparation was made from the long bones of the same tissue donor; the only excipient material was water. A single failing tooth was atraumatically extracted from each study subject, and the socket was debrided. Intact sockets were grafted with DBM putty (n = 6), and sockets with buccal defects were grafted with DBM putty with bone chips (n = 6). A bovine pericardium membrane was draped over the graft site, and tension-free primary closure was obtained. After 6 months of healing, a trephine biopsy was taken from the center of each graft, and then, a dental implant was placed. Two subjects were withdrawn, and histologic data could not be obtained from 2 other patients. Mean new bone fill was 40.28% for DBM putty (n = 5) and 44.60% for DBM putty with bone chips (n = 4). Both preparations maintained ridge dimensions and, despite ongoing bone turnover, produced adequate mineralized tissue that enabled implant placement at 6 months. This finding warrants further research.

Immediate implant placement into extraction sockets has been widely reported in the dental literature, but few studies have evaluated immediate loading of such implants. This retrospective study evaluated 206 implants placed into fresh extraction sites using a flapless technique, followed by immediate provisionalization with nonoccluding single-tooth restorations and definitive restoration within 2 weeks. Cumulative survival and success rates were 98.77% (mean follow-up, 23.1 months). Periodontitis did not influence the outcome adversely. Within the limitations of this study, immediate implant placement and restoration, followed by definitive loading within 2 weeks, achieved outcomes comparable to those historically reported for delayed implants.

The sequelae of socket collapse and localized ridge resorption after tooth extraction in the posterior maxilla can adversely affect esthetics, function, and future implant placement. Immediate grafting of extraction sockets may help to preserve natural ridge contours; but lack of available soft tissue can prevent primary closure or exert tension that hampers graft turnover and compromises the visible gingival scallop. Exposed barrier membranes may also be susceptible to bacterial infection that may lead to secondary graft failure. The rotated pedicle palatal connective tissue flap is a relatively simple technique for soft tissue coverage of grafted sockets without excessive tension. This article presents the technique.