Andrada Soancă

Background/Objectives: In this prospective clinical follow-up study, we aimed to evaluate the long-term periodontal responses over a five-year follow-up period associated with Class II direct posterior restorations placed using two different restorative approaches. Materials and Methods: Thirty-one Class II posterior restorations in 25 patients were included. Eighteen were performed using a bulk-fill approach with Admira Fusion X-tra^® (VOCO, Cuxhaven, Germany), whereas thirteen used the proximal wall approach with Admira Fusion^® (VOCO, Cuxhaven, Germany). Periodontal parameters, including plaque control record, gingival bleeding index, probing depth, and clinical attachment loss, were recorded at baseline and five years using standardized periodontal examination procedures. Data were expressed as mean ± standard deviation and analyzed using repeated-measures ANOVA. Given the limited sample size, the statistical analyses were considered exploratory. Results: The plaque control record decreased from baseline to the five-year follow-up, with a significant overall effect of time (F = 4.789, p = 0.037), while the time × restorative approach interaction was not significant (p = 0.694). The gingival bleeding index showed a slight numerical increase over the five-year period (25.52 ± 27.20% at baseline versus 27.00 ± 26.11% at five years); however, neither the effect of time (F = 0.139, p = 0.712) nor the time × restorative approach interaction (F = 0.505, p = 0.483) was statistically significant. Probing depth and clinical attachment loss remained relatively stable throughout the observation period, with no statistically significant time or interaction effects. Overall, no statistically significant time × restorative approach interactions were observed, indicating that longitudinal changes in the evaluated periodontal parameters did not differ significantly between the restorative approaches. Conclusions: Within the limitations of this exploratory clinical study, both ormocer-based restorative protocols were not associated with detectable deterioration in the evaluated periodontal parameters over the five years of follow-up.

Background/Objectives: To evaluate the clinical effects of alveolar ridge preservation using a hyaluronic acid-based product combined with a resorbable collagen cone compared with spontaneous healing. Methods: In this prospective pilot comparative clinical study, extraction sockets were treated either with hyaluronic acid and a collagen cone (test group) or left to heal spontaneously (control group). Mesial and distal ridge height changes (ΔHm, ΔHd), ridge width reduction (ΔW), buccal mucosal thickness changes (ΔTmb), and occlusal mucosal thickness at 3 months (TmoT3) were assessed. Early wound healing was appreciated at 14 days follow-up, and postoperative complications after 7 and 14 days. Results: Complete 3-month follow-up data were available for 18 test and 14 control patients. Mesial bone loss was significantly lower in the test group than in controls [test ΔHm = 1.0 (1.0–1.0) vs. control ΔHm = 2.0 (1.0–2.0); p < 0.001]. Horizontal ridge width reduction was significantly lower in the test group [ΔW = 1.0 (1.0–1.0) vs. 2.0 (1.0–2.0); p = 0.021]. Buccal mucosal thickness was better maintained in the test group [ΔTmb = 0.0 (0.0–0.5) vs. 1.0 (0.5–1.0); p < 0.001], while TmoT3 was greater in the test group, in an exploratory analysis (p = 0.049). A statistically significant difference in early wound-healing scores favoring the test group was observed [4.0 (4.0–5.0) vs. 4.0 (3.0–4.0); p = 0.032]. No statistically detectable difference in postoperative complications was observed between groups. Conclusions: Alveolar ridge preservation was associated with reduced mesial vertical and horizontal dimensional changes and more favorable soft tissue outcomes compared with spontaneous healing. These preliminary findings should be considered hypothesis-generating.

Background: Mechanical subgingival instrumentation remains the gold standard in periodontitis treatment; however, it may leave residual debris and induce surface alterations. Adjunctive strategies such as air polishing and ethylenediaminetetraacetic acid (EDTA) might optimize root surface conditions. Objective: To evaluate, by scanning electron microscopy (SEM), the effects of scaling and root planing (SRP) combined with EDTA, with or without adjunctive erythritol- or glycine-based air polishing, on root surface alterations and smear layer formation. Materials and Methods: Ten extracted human teeth affected by periodontitis (yielding twenty samples) were included. Two teeth served as descriptive controls. The remaining teeth were allocated to four treatment groups. The first three groups included samples obtained from the middle portion of the roots: S (SRP + EDTA), Se (SRP + erythritol air polishing + EDTA), and Sg (SRP + glycine air polishing + EDTA). The fourth group, Js, consisted of samples from the cementoenamel junction (CEJ) treated with SRP + EDTA. SEM images were appreciated qualitatively and assessed using ordinal scores (0–3) for marks, cracks (×100), and smear layer (×1000). Non-parametric statistics were applied. Results: A significant difference in mark scores was found among S, Se, and Sg samples (H = 13.411, p = 0.001), with Se samples showing lower mark scores than S (p = 0.001). Crack scores also differed among groups (H = 12.038, p = 0.002), with higher values observed in Se compared to S (p = 0.001). Smear layer scores did not differ among groups (H = 0.102, p = 0.950). Compared with S samples, Js differed only in marks (p = 0.009), with no significant differences in cracks or smear layer. Conclusions: Within the limitations of this in vitro study, root surface alterations and smear layer formation showed variable responses across treatment protocols, with comparable smear layer scores. Similar effects were observed for CEJ and mid-root samples; however, these findings should be interpreted with caution. Further studies are needed to clarify the potential clinical relevance of these observations.

Periodontitis is a biofilm-induced multifactorial disease characterized by non-reversible damage of the periodontal tissues. Dysbiosis of the subgingival microbiota plays a crucial role in periodontitis. In this regard, conventional periodontal treatment consists of subgingival mechanical instrumentation, but adjunctive methods, such as air-polishing powders, have also sparked considerable interest due to their ability to efficiently disrupt biofilm with minimal tissue damage. The aim of this narrative review is to provide an overview and critical discussion of the recent literature on the properties and interactions of air-polishing powders with oral bacteria and soft tissues. Fifteen studies were included. Eight recent clinical studies demonstrate that air-polishing powders (e.g., glycine, erythritol) can significantly reduce periodontal pathogens, thereby supporting their role in effective biofilm control; In vitro evidence from four included studies indicates cell-type-specific responses to different powders, with trehalose demonstrating superior biocompatibility compared with glycine and erythritol/chlorhexidine formulations. This variability highlights the importance of choosing the right powder to improve clinical outcomes and reduce tissue side effects. By integrating microbiological, cellular and histological findings, the objective of this review is to clarify the antibacterial efficacy and biocompatibility of air-polishing powders. Overall, air-polishing powders have been shown to be safe and effective as an adjunctive treatment, in both active periodontal and supportive periodontal therapy.

Background: Maintaining daily optimal dental hygiene, especially in medically vulnerable patients with periodontitis, remains challenging in dental practice. Mobile apps and other digital tools might offer useful support alongside traditional advice. Objectives: This study aimed to develop a mobile health app, PerioSupportPro, that helps patients improve their daily plaque control habits. It also reports on the pilot testing of the app’s usability and users’ perception in a small patient group. Methods: The app was created by a mixed team including periodontists, psychologists, developers, and data protection specialists. The first version included reminders, gamified elements, video tutorials, and motivational messages. After internal testing, a group of 18 patients tested the app and completed a feedback questionnaire that assessed usability (Q3–Q5), educational impact (Q6–Q8), motivation (Q9–Q11), and overall satisfaction (Q12–Q14). Cronbach’s alpha was used to check internal consistency, and non-parametric tests were applied for basic statistical comparisons. Results: The motivation section of the questionnaire showed acceptable consistency (α = 0.784), while usability and educational impact had lower values (α = 0.418 and 0.438). No clear differences were found between age groups. Satisfaction was positively associated with reminders and motivational items. Most appreciated features included reminders, the simple interface, and short videos. Based on the input provided by the questionnaire, a few improvements were made, and a second version of the app was prepared. Conclusions: Early user responses show that PerioSupportPro may help motivate and guide patients in their oral hygiene routine. While still in an early phase, the app seems well-received and ready for future clinical validation with more users.

Background/Objectives: Periodontitis, a prevalent chronic inflammatory disease affecting tooth-supporting structures, has been increasingly linked to systemic conditions such as diabetes mellitus (DM) and cardiovascular diseases (CVDs). This study aimed to evaluate the periodontal status and levels of dipeptidyl peptidase-4 (DPP-4) and galectin-3 (Gal-3) in gingival crevicular fluid (GCF) of patients with periodontitis, heart failure (HF), and diabetes, exploring their potential as biomarkers for disease association. Methods: A cross-sectional study was conducted on 88 patients categorized into four groups: periodontally and systemically healthy (control, C); periodontitis (P); periodontitis and HF (P+HF); and periodontitis, HF, and diabetes (P+HF+D). Periodontal status was assessed using probing pocket depth (PPD) and Gingival Index (GI). GCF samples were collected and analyzed for DPP-4 and Gal-3 levels using ELISA. Statistical analyses were performed to assess differences between groups and potential correlations. Results: Results indicated significantly higher levels of DPP-4 in all test groups compared to controls (p < 0.0001), with the highest levels in the P+HF+D group. Similarly, Gal-3 levels were elevated in periodontitis patients, particularly in those with HF (p < 0.0001), and there was no significant difference between P+HF and P+HF+D groups. No significant differences were observed between smokers and non-smokers regarding these markers. Positive correlations were found between the periodontal parameters and the immunological markers in all test groups. Conclusions: The findings suggest that DPP-4 and Gal-3 may serve as potential biomarkers for periodontitis in association with heart failure and diabetes, with DPP-4 being more upregulated in the association with diabetes and Gal-3 with heart failure.

Background/Objectives: Tooth extraction induces significant alveolar ridge dimensional changes and soft tissue modifications, often leading to challenges in implant placement or conventional prosthetic rehabilitation. Alveolar Ridge Preservation (ARP) strategies aim to mitigate post-extraction resorption of the alveolar ridge, enhancing both the quality and quantity of bone and soft tissue during healing. Hyaluronic acid (HYA) has emerged as a promising biological agent for ARP due to its osteoinductive, antimicrobial, and anti-inflammatory properties. However, the effects of HYA in ARP remain inconsistently reported. This study aims to assess current clinical and preclinical evidence regarding the biological effects of HYA and its application in ARP. Additionally, it evaluates HYA’s impact—alone or in combination with other products—on hard and soft tissue dimensional changes, early wound healing, and implant success rates. Methods: A comprehensive electronic literature search was conducted, and studies meeting the inclusion criteria were critically evaluated. Relevant data were extracted from the final selection of articles. Results: Thirteen publications were evaluated. Some studies reported a significantly improved newly formed bone following ARP with intra-socket HYA application as a single approach (p = 0.004). Combining HYA with a bone graft and a free palatal graft resulted in significantly greater amounts of newly formed and mature bone, reduced clinical bone width changes, lower radiographic crestal bone loss (p < 0.01), and diminished radiological volumetric and linear bone resorption (p = 0.018). Short-term follow-up data indicated improved soft tissue healing associated with HYA-based ARP. While HYA appears to have a protective effect on ridge dimensional changes in ARP, other studies reported no significant differences in radiographic bone dimensional changes or soft tissue improvement. Conclusions: The addition of HYA to bone grafts may enhance some ARP outcomes. However, the variability in outcomes and methodologies across the evaluated studies precludes drawing definitive clinical conclusions. Further robust research is needed to clarify HYA’s role in ARP. With respect to clinical significance enhancing the understanding of ARP management strategies and their effects on post-extraction sockets empowers clinicians to make more informed decisions. The knowledge of HYA effects facilitates the selection of personalized ARP approaches tailored to optimize outcomes for subsequent interventions.

(1) Background: This cross-sectional investigation appreciated the role of serum C-reactive protein (CRP), several hematologic-cell markers, and salivary inflammation-related molecules [calprotectin (S100A8/A9), interleukin-1β (IL-1β), kallikrein] to predict periodontitis in patients with atherosclerotic cardiovascular disease (ACVD), arrhythmia, or both. Also, we appreciated the relationship between the inflammatory burden and periodontal destruction with the type of cardiac pathology. (2) Methods: Demographic, behavioral characteristics, periodontal indicators, blood parameters, and saliva samples were collected. (3) Results: All 148 patients exhibited stage II or III/IV periodontitis. Stage III/IV cases exhibited significantly increased S100A8/A9 levels (p = 0.004). A positive correlation between S100A8/A9 and IL-1β [0.35 (<0.001)], kallikrein [0.55 (<0.001)], and CRP [0.28 (<0.001)] was observed. Patients with complex cardiac involvement had a significantly higher number of sites with attachment loss ≥ 5 mm [19 (3–30)] compared to individuals with only arrhythmia [9 (3.25–18)] or ACVD [5 (1–12)] [0.048♦ {0.162/0.496/0.14}]. (4) Conclusions: Severe, extensive attachment loss may be indicative of patients with complex cardiac conditions, which underscores the essential role of periodontal status in relation to systemic diseases. The correlations between the rising trends of the inflammatory parameters suggest a potential interconnection between oral and systemic inflammation.

Introduction: Periodontitis, an infectious inflammatory condition, is a key contributor to sustained systemic inflammation, intricately linked to atherosclerotic cardiovascular disease (CVD), the leading cause of death in developed nations. Treating periodontitis with subgingival mechanical instrumentation with or without adjunctive antimicrobials reduces the microbial burden and local inflammation, while also potentially bringing systemic benefits for patients with both periodontitis and CVD. This review examines systemic effects of subgingival instrumentation with or without antimicrobial products in individuals with periodontitis and CVD, and explores intricate pathogenetic interactions between periodontitis and CVD. Material and Methods: English-language databases (PubMed MEDLINE and Cochrane Library) were searched for studies assessing the effects of nonsurgical periodontal therapies in periodontitis patients with or without CVD. Results: While the ability of periodontal therapy to reduce mortality- and morbidity-related outcomes in CVD patients with periodontitis remains uncertain, some studies indicate a decrease in inflammatory markers and blood cell counts. Subgingival mechanical instrumentation delivered over multiple short sessions carries lower risks of adverse effects, particularly systemic inflammation, compared to the full-mouth delivery, making it a preferable option for CVD patients. Conclusions: Subgingival mechanical instrumentation, ideally conducted in a quadrant-based therapeutic approach, to decontaminate periodontal pockets has the potential to reduce both local and systemic inflammation with minimal adverse effects in patients suffering from periodontitis and concurrent CVD.

(1) Background: This study aimed to assess the periodontitis burden in systemic sclerosis patients and the possible association between them, and the degree to which some potential risk factors and two potential diagnostic biomarkers may account for this association. (2) Methods: This cross-sectional study included a test group (systemic sclerosis patients) and a control group (non-systemic sclerosis patients). Both groups benefited from medical, periodontal examination and saliva sampling to determine the salivary flow rate and two inflammatory biomarkers (calprotectin, psoriasin). A systemic sclerosis severity scale was established. (3) Results: In the studied groups, comparable periodontitis rates of 88.68% and 85.85%, respectively, were identified. There were no significant differences in the severity of periodontitis among different systemic sclerosis severity, or in the positivity for anti-centromere and anti-SCL70 antibodies. Musculoskeletal lesions were significantly more common in stage III/IV periodontitis (n = 33, 86.84%) than in those in stage I/II (n = 1, 100%, and n = 3, 37.5%, respectively) (p = 0.007). Comparable levels of the inflammatory mediators were displayed by the two groups. There were no significant differences in calprotectin and psoriasin levels between diffuse and limited forms of systemic sclerosis. (4) Conclusions: Within the limitations of the current study, no associations between systemic sclerosis and periodontitis, or between their risk factors, could be proven.