Mariusz Lipski

Connective tissue grafts (CTGs) are widely used in periodontal and peri-implant plastic surgery, but palatal harvesting is associated with donor-site morbidity. This narrative review summarizes complications, technical pitfalls, and risk-reduction strategies related to subepithelial connective tissue grafts and de-epithelialized gingival graft harvesting. Subepithelial techniques enable primary closure but require adequate residual flap thickness and controlled dissection, whereas de-epithelized grafts provide better control of graft dimensions but leave an open palatal wound. Donor-site morbidity is influenced by patient-related factors, palatal anatomy, graft size, wound configuration, and surgical execution. Pain and bleeding are the most frequently reported early outcomes, while dehiscence, necrosis, infection, sensory disturbances, and symptomatic scarring remain poorly quantified. Risk may be reduced through careful assessment, minimal effective graft dimensions, atraumatic technique, reliable hemostasis, wound protection, and clear postoperative instructions. Standardized CTG-specific outcome measures and risk-assessment tools are needed to improve evidence comparability and clinical decision-making.

Periodontitis is a chronic inflammatory disease associated with subgingival dysbiosis and altered host response. Although it is usually considered a local disease of the tooth-supporting tissues, it may also interact with distant mucosal and systemic compartments. One possible explanation is the oral–gut–systemic axis. In this model, oral bacteria, microbial products and inflammatory mediators are swallowed and reach the gastrointestinal tract. In susceptible hosts, these signals may affect gut microbial ecology, epithelial barrier integrity, mucosal immunity and microbial metabolite pathways. Human studies show links between periodontitis, altered oral and gut microbial communities, oral–gut microbial signatures and systemic metabolomic changes. Experimental studies provide stronger mechanistic support. They suggest that periodontal pathogens, particularly Porphyromonas gingivalis, may promote gut dysbiosis, barrier dysfunction, endotoxemia, inflammasome activation, T helper 17/regulatory T cell (Th17/Treg) imbalance and changes in metabolite signaling pathways. Candidate pathways include aryl hydrocarbon receptor (AHR) signaling, suppression of G protein-coupled receptor 109A (GPR109A), short-chain fatty acid-related pathways and trimethylamine N-oxide (TMAO) metabolism. Inflammatory bowel disease is currently the most developed disease-specific model. Metabolic dysfunction-associated steatotic liver disease (MASLD), non-alcoholic fatty liver disease (NAFLD), rheumatoid arthritis, cardiometabolic metabolite pathways and gastrointestinal cancer models are less mature extensions. This review summarizes current evidence and identifies the need for longitudinal studies, strain-level source tracking, multi-omics, immune phenotyping and disease-specific intervention studies. At present, the concept is biologically plausible, but clinical translation remains premature.

Connective tissue grafts (CTGs) remain a vital component in periodontal and pe-ri-implant plastic surgery; however, their harvesting creates a second surgical wound at the palatal donor site. This narrative review critically synthesizes the evidence on com-plications, technical pitfalls, and strategies for reducing donor-site morbidity following the harvesting of subepithelial connective tissue grafts and de-epithelialized gingival grafts. Subepithelial harvesting techniques support primary wound closure but require adequate residual flap thickness and careful dissection. In contrast, harvesting de-epithelialized gingival graft creates an open wound that demands effective hemostasis and protection; however, this approach provides greater control over graft dimensions and composition. No single harvesting technique or adjunctive intervention is universally superior. In addition to the harvesting technique and the resulting wound configuration, donor-site morbidity is determined by interactions among patient-related medical factors, palatal anatomy, graft dimensions and composition, and performance of the surgery. Pain and bleeding are the most frequently assessed early outcomes, whereas wound dehiscence, necrosis, infection, persistent sensory disturbances, and symptomatic scarring remain insufficiently quantified. The risk of postoperative morbidity and complications may be reduced through careful medical and anatomical assessment, the use of the minimum effective graft dimensions, atraumatic tissue handling, preservation of adequately vascularized residual tissues, effective hemostasis with appropriate wound protection, and easy-to-follow postoperative instructions for patients. Standardized endpoints, outcome measures, assessment intervals, and CTG-specific risk-assessment tools are needed to improve the comparability of evidence and guide clinical decision-making.

Periodontitis is a chronic inflammatory disease which is initiated by dysbiotic biofilms and maintained by a host who is permissive to inflammation resulting in continuous destruction of periodontal supporting structures. Periodontitis occurs frequently with obesity and type 2 diabetes mellitus and the broader cardiometabolic risk state leading to investigations into the common immunometabolic pathways that link these conditions. Adiponectin, an insulin sensitizing and anti-inflammatory adipokine which can also act as a vasculoprotective and bone-related factor, has been studied as a potential modulator of the relation between periodontal inflammation and systemic metabolic disturbance. This narrative review summarizes the biology of adiponectin and its receptors, human findings relating to both the local and circulating forms of adiponectin in periodontal health and disease, the mechanism in cell and animal models and translational implications and limitations. The literature was reviewed in a narrative manner with particular attention to study quality, compartment-specific biology and any conflicts in evidence and the difference between biological plausibility and clinical relevance. A tendency for a reduction in the circulating, saliva and gingival crevicular fluid levels of adiponectin in periodontitis in human studies, particularly those with co-existing obesity and type 2 diabetes mellitus, can be demonstrated but these finding are often disparate due to variable methods in case definitions, assay techniques, metabolic background of subjects and other confounders. Experimental findings may establish biological plausibility by linking adiponectin signalling with the mechanisms which affect inflammatory responses, endothelial function and matrix homeostasis, osteoclastogenesis and subsequent alveolar bone loss, although adiponectin signalling appears context-specific in its actions and this does not confirm clinical relevance. Evidence suggests adiponectin is a biologically significant, but context-dependent factor within the immunometabolic network which connects periodontal disease with the systemic condition, rather than a sole marker or clinically recognized target for therapeutic intervention.

Objectives: Achieving a smooth tooth surface following periodontal instrumentation is critical for maintaining periodontal health and minimizing plaque and calculus reaccumulation. This narrative review aimed to synthesize preclinical laboratory-based evidence regarding the effects of periodontal instrumentation techniques on enamel and cementum surface roughness and hard-tissue loss. Methods: A focused literature search was conducted using the PubMed database to identify relevant in vitro and in vitro/in vivo hybrid studies published within the last 15 years. This review focused on ultrasonic scaling, hand instrumentation, and air polishing of human teeth during periodontal treatment. Results: Periodontal instrumentation was associated with surface alterations of enamel and cementum, with the extent of these changes depending on instrumentation parameters. Manual instrumentation was generally associated with greater surface irregularities and increased cementum removal, whereas ultrasonic scaling tended to produce more uniform surface characteristics. However, outcomes varied depending on instrumentation parameters. Air-polishing systems were described as less abrasive, particularly in biofilm management. Conclusions: Within the limitations of predominantly in vitro evidence, periodontal instrumentation appears to alter dental hard tissues to varying degrees depending on the technique and application. The clinical relevance of these findings remains uncertain, as the evidence was primarily laboratory-based and may not fully reflect clinical conditions or predict long-term outcomes.

Background/Objectives: Evidence regarding the effect of malocclusion on periodontal health is contradictory. This systematic review with meta-analysis seeks to summarize the available scientific evidence on the relationship between malocclusion and periodontal health in children and adolescents. Methods: A review of four electronic databases (PubMed, Scopus, Embase, and Web of Science) was performed. Observational studies were included if they investigated the link between malocclusion and periodontal health in children and adolescents. The quality of the studies included in the review was determined using the Newcastle–Ottawa Scale (NOS). A meta-analysis was conducted on binary outcomes using random-effect models. The Grading Recommendations Assessment, Development and Evaluation (GRADE) tool was used to determine the certainty of the evidence for each outcome. Results: The initial search yielded 774 potential articles. Nineteen articles were selected for the final qualitative analysis, and four of these were included in the meta-analysis. Certain malocclusion traits appear to be associated with less favorable periodontal health indicators in children and adolescents. Quantitative synthesis restricted to studies using the Gingival Bleeding Index (GBI) suggests that malpositioned teeth, such as crowding or lack of spacing, and Class II or Class III molar relationships may be associated with a higher odds of gingivitis in individuals under 18 years of age. The overall quality of evidence of the studies was very low, according to the GRADE criteria. Conclusions: Observational cross-sectional evidence of very low certainty suggests an association between certain malocclusions (crowding, lack of spacing, Class II or Class III molar relationships) and increased odds of gingivitis in children and adolescents. Evidence regarding dental plaque accumulation is inconsistent and limited by substantial heterogeneity across studies. Causality cannot be inferred, and further high-quality longitudinal studies are required.

Basic knowledge of tooth anatomy is essential for endodontic success. The most common configuration of the mandibular second molar is the presence of two roots. However, single‐, three‐, four‐, and even five‐rooted forms have also been reported in the literature. The purpose of this study is to present a clinical case of a mandibular second molar with four roots. Morphology was assessed using CBCT examination, which revealed that the patient has bilateral four‐rooted second lower molars—an anomaly that, to our knowledge, is extremely rare in the literature. Awareness and careful diagnosis of such anomalies are crucial to ensure all canals are treated, improving clinical outcomes and preventing treatment failure.

Oral lichen planus (OLP) is a chronic immune-mediated inflammatory disorder of the oral mucosa associated with oxidative stress, epithelial degeneration, and persistent T-cell–driven inflammation. Despite numerous therapeutic approaches, disease control and mucosal healing remain challenging. This review aims to summarize current evidence on the biological functions of vitamin C (VitC) relevant to OLP pathogenesis and to evaluate its potential as an adjunctive therapeutic agent. A comprehensive literature review was performed to identify studies exploring the molecular mechanisms of VitC in oxidative stress modulation, epithelial integrity, and immune regulation, as well as clinical and experimental data assessing its therapeutic outcomes in OLP. VitC has various effects relevant to OLP, including scavenging of reactive oxygen species, stabilization of epithelial structures, regulation of apoptosis, and modulation of cytokine expression. Preliminary studies indicate beneficial effects on oxidative balance, inflammation, and tissue repair; however, the evidence is still limited and varies among different study designs and formulations. VitC represents a biologically plausible and safe adjunct in OLP management, acting at multiple pathobiological levels. Further well-designed clinical trials are needed to establish optimal dosing, delivery strategies, and long-term outcomes.

Interleukin 17 (IL-17) is a crucial mediator at the interface of periodontal dysbiosis and host immunity. This review synthesizes current evidence on IL-17 in periodontitis (PD), its systemic connections, and the role of IL-17 gene variants. Clinical and experimental studies show that IL-17 rises in periodontal disease and is associated with the severity of PD via action on epithelial, stromal and osteoblastic cells to promote chemokine release, neutrophil recruitment, cyclooxygenase 2 and prostaglandin E2 synthesis, RANKL expression, osteoclastogenesis, and matrix metalloproteinase activity. Periodontopathogens Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans pre-activate the local inflammation-maintaining Th17 response. There is converging evidence linking IL-17-centered signaling with rheumatoid arthritis, diabetes mellitus, and psoriasis in favor of a shared inflammatory network in barrier tissues and synovium. Despite these associations, IL-17 biology is contextually determined with mucosal defense and bone homeostatic roles that caution against unidimensional explanations. Evidence on IL-17A and IL-17F polymorphisms is still heterogeneous across populations with modest and variable risk associations with PD. Clinically, IL-17 in gingival crevicular fluid, saliva, or serum is a potential monitoring biomarker when utilized along with conventional indices. Therapeutically, periodontal therapy that reduces microbial burden may inhibit IL-17 function, and IL-17-targeted therapy has to balance potential benefit to inflammation and bone resorption against safety in oral tissues. The following research must utilize harmonized case definitions, standardized sampling, and multiethnic cohorts, and it must include multiomics to be able to differentiate between causal and compensatory IL-17 signals.

Background/Objectives: The objective of this in vitro study was to compare and evaluate the in vitro antimicrobial effectiveness of Endosal, Octenisolv, and Endoxal against intracanal Enterococcus faecalis. Methods: The study sample consisted of 84 extracted single-rooted human teeth, which were divided into seven groups (12 roots in each group): Group 1—Endoxal, Group 2—Octenisolv, Group 3—Endosal, Group 4—15% ethylenediaminetetraacetic acid (EDTA), Group 5—2% sodium hypochlorite (NaOCl), Group 6—0.9% sterile saline solution (NaCl), and one positive control group where no irrigant was used. The roots were sterilized within an autoclave for 30 min at 121 °C and then contaminated with E. faecalis bacteria, after instrumentation and removing the smear layer from canals. The root canals were irrigated using a side-vented needle, and then ISO size 40 H-file was used to obtain fine dentine chips. Aliquots taken from the canals were plated on blood agar broth and the plates were incubated for 36 h. Results: In this study, significant differences were observed between the antimicrobial activity of Endoxal, Octenisolv, Endosal, 2% NaOCl, and sterile saline solution. Conclusions: The compound irrigants Endosal, Endoxal, and a novel irrigant containing disodium edetate and octenidine, which were evaluated in this study, exhibited relatively good antimicrobial properties against Enterococcus faecalis. The use of Endosal, Octenisolv or Endoxal appears promising, yet their clinical efficacy remains to be confirmed through further studies.