James Rudolph Collins

Background/Objectives: Autologous dentin matrix (ADM) has been suggested as a biologically plausible biomaterial for alveolar bone regeneration after tooth extraction. However, clinical evidence regarding its biological activity and early healing outcomes is limited. This exploratory, randomized controlled pilot study aimed to descriptively assess early alveolar healing patterns and bone morphogenetic protein 4 (BMP4) expression following tooth extraction using ADM compared with other grafting approaches. Methods: Patients requiring tooth extraction were allocated to one of four groups: ADM, xenograft, ADM combined with platelet-rich fibrin, and a graft-free control group. Histological and immunohistochemical analyses were performed four months after extraction to descriptively assess cellular features of healing and BMP4 expression. The trial was registered at the Brazilian Registry of Clinical Trials (ReBEC; RBR-24mdgrf) and conducted under prior ethics committee approval. Results: BMP4 expression was detected in 67.9% of the analyzed histological fields, predominantly localized in osteocytic, osteoblastic, and medullary areas. Although descriptive differences in BMP4-positive fields were observed among the groups, no statistically significant differences were identified between the groups. Histological evaluation revealed an active cellular environment across all treatment modalities, consistent with early post-extraction healing. No adverse events related to surgical procedures or grafting materials were reported during the study period. Conclusions: Within the limitations of this pilot randomized clinical trial, ADM exhibited consistent biological behavior during early post-extraction alveolar healing. The observed BMP4 expression likely reflects a general physiological healing response rather than a material-specific effect. This finding supports the biological plausibility of dentin-derived grafts as osteoconductive biomaterials. These findings are hypothesis-generating, and larger, adequately powered randomized clinical trials with standardized molecular and histological assessments are required to determine their clinical relevance.

Advanced imaging and direct metal laser sintering enable fabrication of patient‐specific titanium meshes with precise anatomical adaptation, improving stability, surgical predictability, and rehabilitation outcomes in edentulous patients with severe atrophic arches. This article evaluates the long‐term clinical outcomes of customized subperiosteal implants (CSIs) for the rehabilitation of severely atrophic maxillae. Two patients with Cawood and Howell Classes V and VI edentulous maxilla atrophy were treated using customized subperiosteal titanium implants. Implant design and surgical planning of CSIs were performed using cone‐beam computed tomography and intraoral scanning, followed by virtual planning and additive manufacturing. A patient‐specific three‐dimensional printed surgical guide was used to facilitate bone reduction and implant positioning. Following implant placement, an immediately loaded fixed provisional prosthesis was delivered. After a healing period of 4 months, a definitive fixed prosthesis was connected to the subperiosteal implants. Clinical outcomes were assessed over a 42‐month follow‐up period, focusing on soft tissue health, prosthetic performance, and biological or mechanical complications. Both patients demonstrated favorable esthetic and functional outcomes throughout the follow‐up period. No postoperative, biological, or mechanical complications were observed. Implant stability and peri‐implant tissue conditions remained satisfactory, with no evidence of adverse clinical findings. The findings of these case reports indicate that CSIs may represent a reliable long‐term alternative to regenerative procedures in patients with severe maxillary atrophy. This approach allows immediate implant loading and offers a potential treatment option for the fixed prosthetic rehabilitation of edentulous patients.

Periodontal regeneration (PR) could represent a viable treatment alternative for severely compromised teeth. This case series presents the long-term benefits of PR with up to 13 years of follow-up. A total of six teeth in five patients were treated for intrabony defects using PR. The treatment involved the elevation of a mucoperiosteal flap, root instrumentation, and filling the bony defect with bone substitutes. Following PR, a significant reduction in probing depth (PD) was observed (mean 9.5 ± 1.87 mm; p = 0.03) along with a statistically significant gain in clinical attachment level (CAL) (mean 8.33 ± 1.03 mm; p = 0.03). Radiographic bone defect fill at the defect site was also verified (mean 9.67 ± 2.25 mm; p = 0.03). This case series demonstrated that PR led to reduced PD with minimal gingival recession, gain in CAL, and bone fill at defect sites, even in complex periodontal defects extending to the apical portion of the root, over a follow-up period of up to 13 years, indicating it as an effective and predictable treatment alternative.

Periodontal regeneration (PR) could represent a viable treatment alternative for severely compromised teeth. This case series presents the long‐term benefits of PR with up to 13 years of follow‐up. A total of six teeth in five patients were treated for intrabony defects using PR. The treatment involved the elevation of a mucoperiosteal flap, root instrumentation, and filling the bony defect with bone substitutes. Following PR, a significant reduction in probing depth (PD) was observed (mean 9.5 ± 1.87 mm; p = 0.03) along with a statistically significant gain in clinical attachment level (CAL) (mean 8.33 ± 1.03 mm; p = 0.03). Radiographic bone defect fill at the defect site was also verified (mean 9.67 ± 2.25 mm; p = 0.03). This case series demonstrated that PR led to reduced PD with minimal gingival recession, gain in CAL, and bone fill at defect sites, even in complex periodontal defects extending to the apical portion of the root, over a follow‐up period of up to 13 years, indicating it as an effective and predictable treatment alternative.

Objective: This study evaluated alveolar preservation using leukocyte-platelet rich fibrin (L-PRF) in adult patients, comparing it to control alveoli. Methods: Conducted from 2016 to 2018, the study included 17 adult patients, aged between 20 and 45 years, diagnosed with either Class I or Angle Class II-1 malocclusion. Participants underwent first premolar extractions, with L-PRF treatment applied to one side of their mouth, while the other side served as a control. This retrospective study compared tomography data from these patients, who also underwent maxillary canine retraction. One side of the mouth was treated as an experimental alveolus, preserved with L-PRF, and the other as a control. Data normality was assessed using the Shapiro-Wilk test. The Wilcoxon test was used for group comparisons, and the McNemar test was applied to fenestrations. Results: No statistically significant differences were observed in root length changes and surrounding bone tissue between the two sides (P > 0.05). Conclusion: The study found no significant differences in root length reduction and changes in supporting bone tissue between the experimental and control sides. This suggests that alveolar preservation with L-PRF does not alleviate the deleterious effects observed during maxillary canine distalization.

The 2024 Consensus on Periodontology for Latin America and the Caribbean addresses the significant public health issue of periodontal diseases, impacting millions in the region. This comprehensive document presents holistic recommendations to standardize diagnostic methodologies, enhance public awareness, and integrate preventive and therapeutic practices into general healthcare. Key areas include understanding the prevalence and impact of periodontal diseases, identifying risk factors, and improving diagnostic, preventive, and treatment strategies. The consensus emphasizes interdisciplinary collaboration, tailored public health interventions, and the importance of continuous monitoring and research. By unifying efforts across various sectors, the consensus aims to reduce the burden of periodontal diseases, thereby improving both oral and general health outcomes in Latin America and the Caribbean.

Periodontal diseases are highly prevalent globally, and represent a significant public health burden that could affect the quality of life in Latin American and in Caribbean countries and territories. The primary objective is to explore the existing research and epidemiological studies on the burden of periodontal diseases, particularly their impact on oral health-related quality of life (OHRQoL) and associations with systemic health conditions in Latin America and the Caribbean (LAC). An electronic literature search was conducted across multiple databases, including MEDLINE (PubMed), Scopus, LILACS, SciELO, and Web of Science, without publication date or language limitations, up until December 2023. Reviewers independently assessed titles and abstracts based on the eligibility criteria. The search yielded 1195 articles, with 63 meeting the inclusion criteria. The results of epidemiological studies showed that periodontitis is extremely prevalent at 90% in LAC; severe periodontitis can affect nearly 10% of the adult population and that periodontitis is aggravated by smoking, poverty, low education level, and limited access to proper dental care. Periodontitis was consistently associated with worse OHRQoL; and causing pain, and/or triggering psychological discomfort, physical disability, and social disability. Associations were also reported between periodontitis and comorbidities such as diabetes, cardiovascular disease, rheumatoid arthritis, respiratory disease, mental illness, and adverse pregnancy outcomes that are also affecting the quality of life of individuals and their families. This scoping review offers a thorough examination of the burden of periodontal diseases in LAC and highlights the significant public health concern that it represents for the region.

Purpose: To identify the relationship between periodontal health knowledge and oral health-related quality of life among Caribbean adults. Materials and methods: A cross-sectional study was conducted in a representative sample from 3 Caribbean cities (weighted N = 1805). Participants completed a questionnaire on oral health knowledge, hygiene habits, and other practices, as well as the Oral Health Impact Profile-14 (OHIP-14) questionnaire. The associations between knowledge and habits and OHIP-14 score and its tertiles were evaluated using negative binomial and multinomial logistic regression models, respectively, adjusting for confounders. Odds ratios and regression coefficients were reported. Results: Participants reporting none, little, and adequate knowledge about gum health had higher odds of being in the worst tertile for OHRQoL, compared to those reporting "good knowledge" (ORnone vs good = 2.38, 95% CI: 1.59-3.54; ORlittle vs good = 1.82, 95% CI: 1.19-2.78; ORadequate vs good = 1.68, 95% CI: 1.11-2.57). Participants reporting toothbrushing >= twice/day were less likely to be in the worst tertile for OHRQoL, compared to those brushing less often (OR = 0.67, 95% CI: 0.48-0.92). Self-reported gum bleeding was associated with double the odds of being in the worse tertile (OR = 2.03, 95% CI: 1.60-2.58). Conclusion: According to the findings of this study, periodontal health knowledge is associated with reduced OHRQoL in Caribbean Adults. In addition, the frequency of brushing and the self-reported gum bleeding was related to a worse quality of life (QoL) level.

Background and Objective: As elsewhere in the world, the prevalence of periodontitis in stages I–II is high in the Latin American population, this scenario emphasizes the need for identification of urgent needs for allocating adequate resources to provide diagnosis, prevention, and treatment of these diseases. The aim of this Delphi study was to predict the trends in periodontology/periodontics in the Latin American region by the year 2030.Methods: A steering committee and an advisory group of experts in periodontology/periodontics were selected from 16 countries. An open questionnaire of 60 questions was validated and used following the Delphi methodology.Results: Two hundred and twenty‐five experts from Latin America answered the two rounds of the questionnaire. Moderate to strong consensus was reached on 45 questions (75%). The prediction was that the prevalence of gingivitis and periodontitis in stages I and II will be maintained, the importance of the link with systemic diseases will increase, and the impact of prevention and periodontal treatment will also increase, mainly in the private sector. There was a strong consensus that plastic and regenerative surgical procedures will increase, as well as the demand for training in the specialty of periodontology.Conclusions: The present study has provided relevant and useful information on predictions in periodontology/periodontics in Latin America, with important level of consensus among experts. It has been predicted that periodontitis will still be a highly prevalent disease, and its links with other medical conditions should demand more attention by health authorities to develop adequate prevention and management policies and strategies.

Aerosols produced by dental handpieces represent a permanent risk of disease transmission in the dental environment. The current study evaluated the effects of natural ventilation (open windows) on Streptococcus mutans airborne contamination by dental handpieces in simulated clinical conditions. A dental phantom was placed on a dental chair at a standard university dental clinic operatory. An S. mutans suspension was infused into the phantom's mouth while an operator performed standardized dental procedures using low (contra‐angle) and high speed (turbine) dental handpieces or an ultrasonic scaler, with windows open or closed. Selective medium Petri dishes were placed in 18 sites of the operatory environment to evaluate contamination topographically. Sites were clustered as: wall, floor, ceiling, dental chair, and cabinet. Contamination was expressed as log₁₀CFU/cm². A linear mixed model analysis was used, nesting the sites within each ventilation and handpiece combination. Open windows significantly reduced contamination. The high‐speed handpiece provided the highest contamination, followed by the ultrasonic scaler and the low‐speed handpiece. Contamination values were much smaller at the ceiling, and much larger at the chair. Opening windows produced more homogeneous contamination of the operatory compared to closed windows. Natural ventilation during dental procedures decreases contamination and affects its topographical distribution.