Alkisti Zekeridou

Background: Population aging is reshaping prosthodontic care for both partially and completely edentulous individuals. In older adults, conditions such as frailty, comorbidities, polypharmacy, and cognitive decline can have a direct impact on the biological and biomechanical demands of implant therapy, thereby influencing the success of implant treatment. Materials and Methods: This narrative review synthesizes evidence on implant therapy in older patients, integrating prosthetic and biomechanical considerations with patient‐related factors. The literature search addressed implant survival, complications, prosthetic and material design, peri‐implant soft tissue considerations, and treatment options such as shortened dental arch approaches, implant‐assisted removable partial dentures (IARPDs), implant overdentures, and complete dentures, as well as maintenance strategies with patient and caregiver education. Results: Implant survival in older patients remains high, and age alone should not be considered as a limiting factor for implant treatment. Hygiene‐oriented prosthetic designs, including non‐mucosa‐contact intaglio surfaces and emergence angles less than 30°, were associated with reduced plaque accumulation and peri‐implant bone loss in older adults. While limited keratinized mucosa correlated with greater plaque and recession, phenotype modification should be evaluated on a case‐by‐case basis, carefully weighing the benefits against the surgical burden for the older patient. Ceramic materials accumulate less plaque as compared with processed acrylic resin, and veneered zirconia remained more prone to chipping than monolithic zirconia. Alternative treatment options—such as overdentures to enhance bite force, a shortened dental arch when posterior implants are contraindicated, or IARPDs to improve stability—may be especially appropriate for older patients with functional limitations. Caregiver participation and structured maintenance significantly reduce peri‐implantitis risk. Conclusion: Implant therapy in older patients, including individuals aged 75 years and above, is highly feasible when age‐related risks are addressed, prostheses are designed for cleansability and retrievability, and maintenance includes structured follow‐up and caregiver support. Clinical Relevance: Clinicians should emphasize functional goals, hygiene‐accessible designs, pragmatic treatment alternatives, selective peri‐implant soft tissue management when indicated, and personalized maintenance supported by patient and caregiver education.

Social inequalities are strongly associated with disparities in oral health, particularly in the development of childhood caries. This 4-year cohort study analyzed the impact of socioeconomic status (SES)- defined on the basis of the health insurance type- on the prevalence, treatment, and recurrence of dental caries in children. A total of 198 children (21 with social insurance, 177 with private insurance) were included. Caries prevalence at baseline was significantly higher in children with social insurance (95 % with >4 caries) compared to those with private insurance (29 % with >4 caries). No children with social insurance were caries-free, whereas 35 % of those with private insurance were caries-free. Pulpotomy and extraction needs were higher in the socially insured group, with 43 % requiring pulpotomies and 62 % requiring extractions, compared to 12 % and 10 %, respectively, in the privately insured group. General anesthesia (GA) use was more frequent in the socially insured group (72 % vs. 13 %), especially among younger children (100 % of 2-4 years old vs. 25 % in the private insurance group). In contrast, conventional anesthesia was more frequently used in the private insurance group (31 % vs. 14 %). Recall appointments were less frequent in the socially insured group, with 24% having no follow-up, compared to 12 % in the privately insured group. Caries recurrence was higher in the socially insured group (62 % had >3 new carious lesions) compared to the privately insured group, where 38 % of children had no new caries at follow-up. These findings highlight the impact of SES on caries burden, treatment modalities, and the importance of preventive measures for disadvantaged groups.

Introduction: Peri-implantitis is an inflammatory disease that compromises peri-implant tissues and supporting bone, potentially leading to implant loss. Although several surgical treatment strategies have been proposed, it remains unclear whether implant surface characteristics (smooth vs. rough) influence long-term treatment outcomes.Methods: A systematic review was conducted to evaluate clinical studies with a minimum follow-up of 3 years that assessed the outcomes of surgical treatment of peri-implantitis in relation to implant surface type. Data extraction focused on recurrence of peri-implantitis, implant survival, clinical parameters, radiographic outcomes, and the type of surgical approach used (reconstructive vs. non-reconstructive).Results: Seventeen clinical studies were included. Outcomes varied according to implant surface characteristics. Rough (modified) surfaces were generally associated with a higher risk of recurrence of peri-implantitis and implant loss compared with smooth (machined/turned) surfaces. Reconstructive surgical approaches, especially those involving bone grafts and membranes, demonstrated more favorable outcomes compared with non-reconstructive approaches.Discussion: Despite observed trends, the certainty of the evidence remains low due to heterogeneity between studies, small sample sizes, and methodological limitations. Further well-designed long-term clinical trials are needed to clarify the role of implant surface characteristics in the long-term success of peri-implantitis surgical treatment.Systematic Review Registration: PROSPERO (CRD420251129791).

Objectives: We aimed to compare the antibiotic concentrations obtained using the volumetric absorptive microsampling (VAMS) devices with those determined in plasma from conventional venous blood collected within the frame of a pharmacokinetic study of amoxicillin (AMO), metronidazole (MET), azithromycin (AZI), commonly used for periodontal treatment. The suitability and overall, acceptability of the VAMS approach was also ascertained by both participants of the pilot study and dentist practitioners. Materials and methods: Twelve volunteers (6 subjects without periodontal problems (PH), and 6 individuals affected with periodontitis (PP)) were administered 500 mg each of amoxicillin, metronidazole, and azithromycin. Paired venous blood (VB) and capillary VAMS samples were collected at 2-, 6-,10-, 24-, 48- and 96-hours post-antibiotics administration. Antibiotic concentrations were determined using multiplex liquid chromatography coupled tandem mass spectrometry (LC-MS/MS). Statistical analyses included Mann-Whitney U tests and t-tests. Results: Significant differences in antibiotic concentrations were observed between VAMS and venous blood (VB) collection methods, across different time points for the three antibiotics (p < 0.05). AMO concentrations in VB were 3.5-fold higher (p < 0.01) than in VAMS at early time points (2, 6, 10 h (h)). MET levels in VB were 1.5-fold higher than in VAMS at 2 h and 6 h, (p < 0.01), but this difference disappeared after 10 h. Alternately, while AZI levels were similar in VB and VAMs 2 h after administration, AZI concentrations in VB and VAMS declined non parallelly, with VB levels decreasing to about 60 to 25% of those measured in VAMS over the observed 96 h interval. Antibiotic exposures were not different in the PH and PP groups. Differences in antibiotics concentrations determined in VB and VAMS samples are a direct consequence of (i) the matrices used for analyses (plasma in VB, vs. whole blood with VAMS), (ii) the subjects’ hematocrit, and (iii) the distinct cell distribution pattern of antibiotics with AMO characterized by a weak penetration in red blood cells (RBC) while AZI tends to progressively concentrate into RBC. MET was present at higher concentrations in plasma until 6 h which thereafter tended to re-equilibrate equally in plasma and RBC. Conclusion: Though VAMS yielded significantly different results compared to plasma, it effectively reflects the concentration evolution of the antibiotics and could be an alternative in pharmacokinetic studies and therapeutic monitoring. Clinical relevance: VAMS holds promise in advancing therapeutic drug monitoring in periodontal research and clinical practice. Being less invasive than venous puncture it is well accepted by subjects and facilitate blood monitoring in clinical trials and non-hospital settings. Its minimal invasiveness and simplified logistics make it suitable for enhancing precision medicine and pharmaceutical approaches in periodontology.

The primary objective is to critically analyze approaches to local therapy for periodontal disease, particularly in light of its well‐established systemic implications. We specifically address common misconceptions and overestimations regarding the potential of local treatments in contrast to their actual clinical effectiveness. Historically, the therapeutic approach to periodontitis has concentrated on local intervention within periodontal pockets. Local drug delivery systems show potential for targeting periodontal infections with high drug concentrations while minimizing systemic side effects. This could potentially help overcome the challenges posed by microbial biofilms. However, evidence suggests that periodontitis is not a disease affecting only confined areas of a dentition. Currently, in the presence of multiple deep pockets, local therapy is less cost‐effective than systemic antibiotics due to the costs of products and the extensive professional chair time required for their application. Isolated deep pockets in otherwise stable dentitions are often caused by problems that cannot be resolved with antimicrobial agents. Finally, recurrent biofilm formation in residual pockets during the maintenance phase can be addressed through suitable physical rather than chemical procedures.

Diabetes mellitus (DM) poses a significant challenge to global health, with its prevalence projected to rise dramatically by 2045. This narrative review explores the bidirectional relationship between periodontitis (PD) and type 1 diabetes mellitus (T1DM), focusing on cellular and molecular mechanisms derived from the interplay between oral microbiota and the host immune response. A comprehensive search of studies published between 2008 and 2023 was conducted to elucidate the association between these two diseases. Preclinical and clinical evidence suggests a bidirectional relationship, with individuals with T1DM exhibiting heightened susceptibility to periodontitis, and vice versa. The review includes recent findings from human clinical studies, revealing variations in oral microbiota composition in T1DM patients, including increases in certain pathogenic species such as Porphyromonas gingivalis, Prevotella intermedia, and Aggregatibacter actinomycetemcomitans, along with shifts in microbial diversity and abundance. Molecular mechanisms underlying this association involve oxidative stress and dysregulated host immune responses, mediated by inflammatory cytokines such as IL-6, IL-8, and MMPs. Furthermore, disruptions in bone turnover markers, such as RANKL and OPG, contribute to periodontal complications in T1DM patients. While preventive measures to manage periodontal complications in T1DM patients may improve overall health outcomes, further research is needed to understand the intricate interactions between oral microbiota, host response, periodontal disease, and systemic health in this population.

Diabetes mellitus (DM) poses a significant challenge to global health, with its prevalence projected to rise dramatically by 2045. This narrative review explores the bidirectional relationship between periodontitis (PD) and type 1 diabetes mellitus (T1DM), focusing on cellular and molecular mechanisms derived by the interplay between oral microbiota and the host immune response. A comprehensive search of literature published between 2008 and 2023 was conducted to elucidate the association between these two diseases. Preclinical and clinical evidence suggests a bidirectional relationship, with individuals with T1DM exhibiting heightened susceptibility to periodontitis, and vice versa. The review includes recent findings from human clinical studies, revealing variations in oral microbiota composition in T1DM patients, including increases in certain pathogenic species such as Porphyromonas gingivalis, Prevotella intermedia, and Aggregatibacter actinomycetemcomitans, along with shifts in microbial diversity and abundance. Molecular mechanisms underlying this association involve oxidative stress and dysregulated host immune responses, mediated by inflammatory cytokines such as IL-6, IL-8, and MMPs. Furthermore, disruptions in bone turnover markers, such as RANKL and OPG, contribute to periodontal complications in T1DM patients. While preventive measures to manage periodontal complications in T1DM patients may improve overall health outcomes, further research is needed to understand the intricate interactions between oral microbiota, host response, periodontal disease, and systemic health in this population.

Background: The objective of the present survey is to assess the knowledge about the relationship between oral health and diabetes and to identify the practice behaviors of Swiss endocrinologists and general practitioners regarding oral health in diabetic patients. Methods: A thirty- item questionnaire was mailed to 428 internists and 99 endocrinologists working in the French speaking part of Switzerland. Participants were asked about their awareness of the relationship between diabetes and periodontal disease, their practice behaviors as well as their willingness for an interdisciplinary education and collaboration with oral health professionals. The questions were answered according to a three-point or five-point Likert scale. Results: The response rate was 23%. All participants were aware of the inflammatory and infectious nature of periodontal disease. They all agreed that good periodontal health is important for overall health. However, most of the practitioners responded that only rarely received information during their education curricula on the link between systemic and oral health or concerning periodontal problems in diabetic patients (60.9% for endocrinologists and 54.1% for general physicians); thus, only a minority of health practitioners addresses oral health care to their patients (13% and 15.3%, respectively). Both endocrinologists and general health physicians agreed that an oral health screening could be included in their practice (79% for both groups). Conclusions: An interdisciplinary education and collaboration among medical and dental health providers should be established to effectively prevent, manage, and control both diabetes and periodontal disease in diabetic patients.

Background The objective of the present survey is to assess the knowledge about the relationship between oral health and diabetes and to identify the practice behaviors of Swiss endocrinologists and general practitioners regarding oral health in diabetic patients. Methods A thirty- item questionnaire was mailed to 428 internists and 99 endocrinologists working in the French speaking part of Switzerland. Participants were asked about their awareness of the relationship between diabetes and periodontal disease, their practice behaviors as well as their willingness for an interdisciplinary education and collaboration with oral health professionals. The questions were answered according to a three-point or five-point Likert scale. Results The response rate was 23%. All participants were aware of the inflammatory and infectious nature of periodontal disease. They all agreed that good periodontal health is important for overall health. However, most of the practitioners received no information during their education curricula on the link between systemic and oral health or concerning periodontal problems in diabetic patients; thus, only a minority of health practitioners addresses oral health care to their patients. Both endocrinologists and general health physicians agreed that an oral health screening could be included in their practice. Conclusions An interdisciplinary education and collaboration among medical and dental health providers should be established to effectively prevent, manage, and control both diabetes and periodontal disease in diabetic patients.