Houxuan Li

Background: This retrospective analysis aims to assess the efficacy of microscope‐aided implant decontamination combined with surgical intervention for peri‐implantitis and identify factors influencing its success. Methods: Patients diagnosed with peri‐implantitis in at least one implant and treated with microscope‐assisted implant surface decontamination combined with surgery were evaluated. Clinical and radiographic parameters were assessed at baseline, 1‐year, and 3‐year intervals. Disease resolution, defined as ≤1 bleeding site, probing depth (PD) ≤5 mm, and no bone loss >0.5 mm, was the primary outcome. Multilevel regression analysis identified predictors affecting disease resolution. Results: Thirty‐three patients with 50 implants were included. The 1‐year success rate was 92% (N = 46), declining to 80% (N = 40) at 3 years and 76% (N = 38) at final evaluation (37–98 months). At the final visit, 89.4% of implants had PD ≤5 mm, with no suppuration (SUP) in 95.7% of cases. Deepest PD at baseline negatively impacted outcomes. Conclusions: Microscope‐assisted implant decontamination combined with surgical treatment is effective for peri‐implantitis management long‐term, serving as a potential reference for implant decontamination procedures. Further randomized controlled trials should investigate this approach's effectiveness compared to non‐microscope‐assisted decontamination. Key points: This is the first clinical study to our knowledge to demonstrate the long‐term efficacy (up to 8 years) of a microscope‐assisted, multi‐step decontamination protocol combined with surgery for treating peri‐implantitis. The presented protocol achieved high disease resolution rates of 76%–92%, with significant improvements in probing depth, bleeding, and bone level. Microscopic visualization ensures thorough implant surface cleaning, addressing a critical limitation of conventional blind debridement techniques. This study establishes a potential new standard of care for achieving predictable and sustainable outcomes in the management of advanced peri‐implantitis. Plain Language Summary: Dental implants occasionally develop severe infections (peri‐implantitis) that damage supporting bone and gums, often leading to implant failure. To improve treatment, we combined surgery with high‐magnification dental microscopes for precise cleaning of contaminated implant surfaces—enabling clinicians to visually confirm thorough decontamination—followed by bone grafting to regenerate lost tissue. Evaluating 33 patients (50 infected implants) over 3+ years (average 4.5 years), we found 92% of implants successfully controlled infection at 1 year (minimal bleeding, shallow pockets ≤5 mm, no pus, stable bone), declining to 80% at 3 years and 76% at final follow‐up. Bleeding, pus, and deep pockets decreased significantly, while bone levels improved. Implants with deeper initial infections had lower success rates. This microscope‐assisted approach provides effective, lasting management of peri‐implantitis by enhancing cleaning accuracy during surgery, offering a promising clinical strategy. Future studies should compare it directly with non‐microscopic methods.

Objectives: Pannexin1 (Panx1), a channel‐forming protein, has been implicated in multiple forms of programmed cell death. This study aimed to investigate the role and underlying molecular mechanisms of Panx1 in regulating ferroptosis during peri‐implantitis (PI). Material and Methods: Panx1 expression in PI patients was evaluated through bioinformatics analysis and validated using clinical samples. In vitro, Porphyromonas gingivalis ‐stimulated osteoblasts were assessed for changes in Panx1 and ferroptosis‐related markers. After Panx1 inhibition or knockdown, cellular iron content, reactive oxygen species levels, and lipid peroxidation were measured to evaluate ferroptosis. In vivo, a mouse model of P. gingivalis ‐induced PI was established to evaluate the effects of pharmacological Panx1 inhibition on ferroptosis and peri‐implant bone loss. Results: Bioinformatic analysis revealed that Panx1 was significantly upregulated in PI tissue. Clinical samples confirmed that Panx1 expression at both gene and protein levels was markedly elevated in PI tissues compared to healthy controls. In vitro, P. gingivalis upregulated Panx1 expression and induced ferroptosis, characterized by increased lipid peroxidation, iron overload, and ROS accumulation. Panx1 inhibition or knockdown alleviated these ferroptosis‐related changes and was associated with the upregulation of the NRF2/SLC7A11/GPX4 antioxidant signaling pathway. In vivo, Panx1‐inhibited PI mice significantly restored the expression of key anti‐ferroptosis proteins in peri‐implant tissues and markedly reduced vertical and circumferential alveolar bone loss around implants compared to untreated PI mice. Conclusions: Panx1 inhibition suppressed P. gingivalis ‐induced ferroptosis in PI accompanied by the upregulation of the NRF2/SLC7A11/GPX4 antioxidant pathway. Targeting Panx1 may provide a potential therapeutic strategy for treating PI.

Aim: To assess a new material in comparison with free gingival graft (FGG) for increasing the width of keratinised tissue (KT). Material and Methods: Forty‐six participants were randomly allocated to the absorbable gradient membrane (AGM) or the FGG group. This trial used inter‐patient comparison to establish the non‐inferiority of AGM compared to FGG. The primary outcome (KT) was examined from baseline to 3 years after surgery. Secondary outcomes included the plaque index (PI), bleeding index (BI), gingival recession (GR), probing depth (PD), immunoglobulin E (IgE) level, postoperative pain, aesthetics and patient satisfaction. Results: The width of KT in the AGM group was non‐inferior to that of the FGG group at all short‐term follow‐ups (1, 3 and 6 months), with a pre‐defined margin of 1 mm. However, this non‐inferiority disappeared by 3 years after operation. From 6 months to 3 years, the GR associated with FGG significantly decreased, while that associated with AGM showed no significant change between adjacent time points. No significant differences were observed in PI, BI, PD or IgE levels between the groups. AGM required shorter surgery times and secured better aesthetic outcomes than FGG. Conclusion: AGM showed short‐term non‐inferiority to FGG for KT augmentation. However, the non‐inferiority was not sustained at 3 years. Trial Registration: The study was registered with the China Clinical Trial Center under ChiCTR2000034683. Informed consent was obtained from all participants

Objective: This study aimed to elucidate metabolic alterations in gingival crevicular fluid (GCF) during orthodontic tooth movement (OTM) and investigate the role of the succinate-SUCNR1 axis in bone resorption and tooth movement. Results: OTM was accompanied by the change of TCA cycle and increase of succinate in the human GCF. Succinate accumulation was observed in periodontal ligament cells (PDLCs) under compressive force, accompanied by increase of glycolysis and decrease of succinic dehydrogenase activity. Suppression of the succinate-SUCNR1 axis reduced osteoclastogenesis in BMDMs. OTM slowed down in the SUCNR1⁻/⁻ mice when compared with wild mice. Conclusion: OTM is accompanied by the increase of succinate in periodontal tissues. Compressive force induces metabolic reprogramming in PDLCs, leading to enhanced succinate production. Succinate promotes macrophage migration and osteoclast differentiation via the SUCNR1 axis, ultimately facilitating orthodontic tooth movement. These findings provide a new potential therapeutic target for regulating periodontal tissue remodeling during orthodontic treatment.

In clear aligner therapy (CAT), Class II elastics are widely used to reinforce the anchorage during the distalization of upper molars, however, their association with alveolar bone dehiscences (ABDs) and fenestrations (ABFs) in the anterior region remains unclear. The aim of this research is to assess the incidence of ABDs/ABFs in adult patients undergoing non-extraction CAT with Class II elastics, and to explore risk factors associated with the occurrence of ABDs/ABFs. Thirty adult patients with Class II malocclusion who underwent non-extraction CAT with Class II intermaxillary elastics were enrolled in this study. Cone-beam computed tomography (CBCT) images were obtained before (T0) and immediately after (T1) CAT to assess the occurrence of ABDs/ABFs on the labial and lingual sides of anterior teeth. Chi-square tests were used to compare the incidence of ABDs/ABFs at T0 and T1, meanwhile, binary logistic regression was utilized to analyze the risk factors associated with ABDs/ABFs at T1. On the labial side, the incidence of ABDs increased significantly in the mandibular central incisors (from 36.7 to 62.8%, P < 0.05), mandibular lateral incisors (from 36.7 to 70.0%, P < 0.05), mandibular canines (from 31.7 to 53.3%, P < 0.05) and maxillary canines (from 30.0 to 55.0%, P < 0.05). While on the lingual side, it increased significantly in the maxillary central incisors (from 1.7 to 23.3%, P < 0.05), lateral incisors (from 6.7 to 38.3%, P < 0.05), and canines (from 21.7 to 46.7%, P < 0.05). The incidence of ABFs only increased on the labial side of the maxillary canines and mandibular central incisors. The occurrence of maxillary ABDs was strongly associated with the crowding (OR = 1.318, P = 0.007), while the occurrence of the mandibular ABDs was significantly associated with root surface (labial vs. lingual, OR = 1.836, P = 0.008). The incidence of ABDs/ABFs significantly increased after non-extraction CAT with Class II elastics in adults, especially on the labial root surface of the mandibular anterior teeth. Orthodontists should be well aware of the periodontal risks of CAT with Class II elastics.

To explore the incidence and risk factors of open gingival embrasures (OGEs) in the front region of adult none-extraction cases with clear aligner treatment (CAT). This retrospective study included eighty-two adult patients with non-extraction and CAT treatment, all of which were provided by Invisalign. A total of 820 tooth sites were assessed for OGEs in intraoral photographs. These sites were categorized into nonoccurrence group and occurrence group. The parameters– including crown shape, root angulation (parallel root recorded as zero and divergent root as positive), distance between cementoenamel junction, and distance from interproximal contact point (ICP) to alveolar bone crest (ABC)– were compared between occurrence group and nonoccurrence group using independent t-test and were further analyzed based on the severity. Logistic regression analysis was used to determine the significant risk factors of OGEs. The overall incidence of OGEs was 13.4% in the maxilla and 30.7% in the mandible. The highest incidence was found between the mandibular central incisors, reaching 39.02%. Age (Maxilla: OR = 1.119, 95%CI (1.048–1.195); Mandible: OR = 1.068, 95%CI (1.018–1.121), mandibular crowding (OR = 0.846, 95%CI (0.729–0.981), distance between adjacent maxillary teeth at the cementoenamel junction (Maxilla: OR = 2.400, 95%CI (1.146–5.027) and distance from ICP to ABC (Maxilla: OR = 8.046, 95%CI (4.016–16.122); Mandible: OR = 3.475, 95%CI (2.390–5.052) in the maxilla and mandible have significant correlation with the occurrence of OGEs (P<0.05). OGE is a common complication after CAT, adversely affecting the smiling aesthetics. Clinicians should be well aware of risk factors, such as age, degree of dental crowding, and the distance from the ICP to ABC.

Objective: This case report offers information on accurate diagnostic and soft‐ and hard‐tissue reconstruction periodontal surgery deal with “black triangles” in the aesthetic zone of anterior teeth caused by submucous alveolar cleft, which is rare and easily overlooked. Clinical Considerations: Vertical and horizontal bone augmentation was conducted via guided tissue regeneration and alveolar bone grafting (ABG) at the cleft site where favorable bone grafting conditions were absent. A customized, vascularized interpositional periosteal‐connective tissue (VIP‐CT) flap was applied as the barrier membrane to maintain the stability of bone replacement graft and provide soft‐tissue foundation for gingival papilla growth. Adjustment on the contact point position of the anterior teeth and the shapes of crowns induced growth of the gingival papillae with resin restoration. The radiological and clinical parameters, and smiling photographs demonstrated a satisfactory treatment outcome. Conclusions: When the inflammation and local alveolar bone destruction in the anterior area are disproportionate, submucous alveolar cleft should be considered a potential etiology. Surgical treatment combined with resin restoration substantially improved the affected area. Clinical Significance: The hard‐ and soft‐tissue defects can be improved through ABG and VIP‐CT flap in a single surgery.

Peri-implantitis is a pathologic condition associated with dental plaque that occurs in the implant tissue and is characterized by inflammation of the mucous membrane surrounding the implant, followed by the progressive loss of supporting bone. In this study, a case of guided bone regeneration therapy based on plaque control of peri-implant inflammation was reported. Four years after surgery for the left second premolar implant, the patient presented with "left lower posterior tooth swelling and discomfort for more than 2 years". The X-ray periapical film showed a decrease in distal bone mineral density of implant, and the clinical diagnosis was peri-implantitis of the left second premolar. Implants underwent guided bone regeneration and regular periodontal maintenance treatment. Re-examination at 3.5 months, 11 months, 18 months, and 7 years showed that the alveolar bone height and bone mineral density were stable, and the periodontal depth became shallow. However, the gingival recession was mild. In the present case, follow-up at 7 years demonstrated that the clinical periodontal indexes could be remarkably improved after complete periodontal treatment for peri-implantitis, and the alveolar bone could be well restored and regenerated.