Hristina Maynalovska

Background and Objectives: Periodontitis is a chronic multifactorial inflammatory disease characterized by progressive destruction of the tooth-supporting tissues. Although periodontal diagnosis is primarily based on clinical and radiographic parameters, salivary biomarkers may provide additional biological information on inflammatory activity and host-response regulation. Matrix metalloproteinase-9 (MMP-9) is involved in extracellular matrix degradation and periodontal tissue destruction, whereas melatonin is a circadian-related molecule with antioxidant, anti-inflammatory, and immunomodulatory properties. However, evidence regarding the simultaneous assessment of salivary MMP-9 and melatonin using standardized pre-sleep saliva collection remains limited. This pilot study aimed to evaluate salivary melatonin and MMP-9 concentrations in periodontal health and stage III periodontitis, to assess their interrelationship, and to explore their preliminary in-sample ability to distinguish periodontal health from stage III periodontitis. Materials and Methods: This cross-sectional pilot study included 18 systemically healthy non-smoking adults: 9 periodontally healthy participants and 9 patients with stage III periodontitis. Pre-sleep unstimulated saliva was collected between 23:00 and 24:00 h or immediately before sleep, following a standardized protocol. Salivary MMP-9 and melatonin concentrations were determined using enzyme-linked immunosorbent assay. Periodontal diagnosis was established according to the 2017 World Workshop classification. Group comparisons, correlation analyses, and receiver operating characteristic curve analyses were performed as exploratory analyses. Results: Salivary melatonin concentrations were significantly lower in patients with stage III periodontitis than in periodontally healthy participants (p = 0.019), with a large effect size (Hedges’ g = 1.261). Salivary MMP-9 concentrations were higher in the periodontitis group, but the difference was not statistically significant (p = 0.465). No significant correlation was found between salivary melatonin and MMP-9 levels. Receiver operating characteristic analysis suggested preliminary in-sample discriminatory ability for melatonin (AUC = 0.827; p = 0.019), whereas MMP-9 showed limited and non-significant discriminatory ability (AUC = 0.593; p = 0.508). Conclusions: In this pilot sample, lower pre-sleep salivary melatonin levels were associated with stage III periodontitis, whereas MMP-9 showed limited standalone discriminatory ability. These findings should be interpreted as preliminary and hypothesis-generating. The present study does not establish a clinically applicable diagnostic cut-off or validated diagnostic utility for salivary melatonin. Larger, independently validated studies are needed to confirm these observations.

This study aimed to evaluate the influence of two minimally invasive surgical protocols – with different approaches to papilla management – on regenerative outcomes achieved using enamel matrix derivative in combination with bone grafts. Materials and Methods: Two treatment groups were analyzed, comprising a total of 19 patients diagnosed with advanced periodontitis. Group 1 included 11 patients contributing 14 vertical bone defects, treated with a combination of enamel matrix derivative (EMD) and xenograft. Group 2 consisted of 8 patients, also with 14 vertical defects, treated with EMD and allograft. The comparison between the two groups was based on three clinical parameters assessed at the 6-month follow-up: residual probing pocket depth, clinical attachment gain, and residual bone defect depth. The Shapiro–Wilk test was used to assess data distribution. Depending on normality and variance, intergroup comparisons were performed using either the Mann–Whitney U test or Welch’s t-test. Results: Both treatment groups demonstrated similar clinical improvements at 6 months, with no statistically significant differences in residual probing pocket depth, clinical attachment gain, or residual bone defect depth. Conclusion: At the 6-month follow-up, both minimally invasive surgical approaches yielded comparable clinical and radiographic outcomes. Further long-term studies are warranted to assess the potential emergence of differences in soft tissue stability and clinical parameters over time.

The aim of the current study was to analyze and evaluate the outcomes of regenerative therapy using a bone graft and enamel matrix proteins, applied through a minimally invasive surgical approach for the treatment of vertical bone defects. Materials and methods: Ten systemically healthy patients with a total of 30 vertical bone defects were treated using a minimally invasive surgical approach combining enamel matrix derivative (Emdogain) with a bone graft. Probing pocket depth (PPD), clinical attachment level (CAL), and radiographic defect depth were analyzed before and at the 6-month postoperative follow-up. Statistical analysis was performed using descriptive statistics and the paired Student’s t-test (p < 0.05). Results: At the 6-month follow-up, a statistically significant reduction in probing pocket depth (mean reduction: 4.00 ± 1.44 mm; p < 0.0001) and a significant gain in clinical attachment level (mean gain: 4.62 ± 2.13 mm; p < 0.0001) were recorded. Radiographic evaluation also revealed a statistically significant reduction in bone defect depth (mean change: 2.95 ± 1.34 mm; p = 0.0027), with a residual mean depth of 0.57 ± 0.73 mm. Conclusion: The minimally invasive approach using enamel matrix derivatives (EMD) in combination with bone grafting proved effective in the treatment of vertical bone defects. The favorable clinical and radiographic outcomes suggest periodontal stability and support the long-term preservation of the treated teeth.

Biomolecules have gained attention in recent years for their potential to enhance regenerative periodontal therapy. This study compared hyaluronic acid (HA) and enamel matrix derivative (EMD), each combined with a xenogeneic graft, in adults with periodontitis presenting vertical bone loss with an intrabony component ≥3 mm. Seventeen participants contributed 28 defects, assigned in equal numbers to Bio-Oss Collagen^® plus HA gel (hyaDENT BG^®) or Bio-Oss Collagen^® plus EMD (Emdogain^®). Outcomes included reduction in probing pocket depth (PPD), gain in clinical attachment level (CAL), and radiographic measures of residual defect and bone fill, assessed at baseline and 6 months after the surgery. Both approaches produced significant within-group improvements in PPD, CAL, and radiographic bone fill (all p = 0.001). Postoperative values and mean changes did not differ significantly between groups (all p > 0.24). Within the limitations of this small, non-randomized study, the findings indicate that HA gel can achieve clinical and radiographic outcomes comparable to EMD when both are used with a xenogeneic scaffold. These results should be considered preliminary, suggesting that HA may represent a practical and biologically compatible alternative to EMD, particularly in cases where cost, availability, or religious considerations limit its use. Confirmation through larger, randomized, and long-term studies is warranted to validate these observations.

Long-term implant success depends on prosthetically driven three-dimensional positioning and the stability of peri-implant and adjacent periodontal tissues. In partially edentulous patients—especially those with a history of periodontitis—an untreated vertical intrabony defect next to the planned implant site can impair plaque control and jeopardize peri-implant hard-tissue stability. This case report presents a 54-year-old, systemically healthy patient with a history of periodontitis, missing the mandibular right first molar (46) and exhibiting a combined mesial intrabony defect at the adjacent second molar (47). Management combined implant placement at site 46 with minimally invasive regenerative surgery at 47 and soft-tissue phenotype modification using a connective tissue graft. Healing was uneventful, and 6-year follow-up demonstrated stable crestal bone at the implant, sustained radiographic fill of the mesial defect, and favorable, well-contoured peri-implant soft tissues. Results: The results suggest that simultaneous guided implant placement with adjacent defect regeneration and connective tissue grafting may achieve durable hard- and soft-tissue stability over years.

Sleep is a key component of health for every living organism. Insufficient duration and quality of sleep lead to alterations in the systemic immune response, which is bidirectionally associated with periodontal and other systemic inflammatory diseases. The present article aims to analyze key aspects of the pathogenesis of periodontal diseases with focus on essential biomolecules in patients with sleep disturbances, as well as the impact of immunological changes on inflammatory diseases, including periodontitis. Conclusion: Immune regulation that occurs during sleep plays a critical role in maintaining health and controlling a number of systemic inflammatory diseases. This highlights the importance of prevention in patients with sleep disturbances and provides opportunities for new diagnostic approaches.

Background and Objectives: Adequate peri-implant soft tissue dimensions are essential for health, hygiene, and esthetics. When ridge volume is sufficient, phenotype modification may avoid bone grafting. This case report describes a pedicled roll flap performed concurrently with single-stage implant placement after spontaneous socket healing, without bone substitute, and assesses soft-tissue stability with serial intraoral scans. Clinical case: A single-tooth edentulous site underwent prosthetically driven, fully guided implant placement. A modified roll flap with vertical and palatal incisions was prepared; the de-epithelialized crestal connective tissue was elevated and rolled into a buccal envelope to augment thickness. No graft material was used. A provisional crown conditioned the emergence profile. Follow-up included photographs, radiographs, and intraoral scan superimpositions at 2 weeks, 3–4 months, 8 months, and 14 months after implant treatment. Healing was uneventful. Buccal soft-tissue thickness increased, keratinized mucosa was preserved, and midfacial levels remained stable. Emergence profile and papillae integrated harmoniously. Crestal bone levels were stable radiographically. Digital scans corroborated soft-tissue thickness maintenance. No donor-site morbidity occurred. Conclusions: In healed sockets with adequate bone, a modified pedicled roll flap at implant placement can thicken the peri-implant phenotype and achieve stable esthetic integration without bone substitutes.

Periodontitis is a prevalent chronic inflammatory disease with complex etiopathogenesis involving microbial dysbiosis, host immune response, environmental factors, and genetic susceptibility. Among the cytokines implicated in periodontal immunoregulation, interleukin-35 (IL-35) has emerged as a novel anti-inflammatory mediator with potential diagnostic and therapeutic relevance. This narrative review evaluates the role of IL-35 in periodontal disease by exploring its local and systemic expression, response to non-surgical periodontal therapy (NSPT), and association with clinical disease severity. Additionally, current evidence regarding IL-35 gene polymorphisms and their potential contribution to individual susceptibility and disease progression, as well as their relevance in related systemic conditions, is assessed. A comprehensive review and synthesis of recent clinical and experimental studies were conducted, focusing on IL-35 levels in saliva, serum, and gingival crevicular fluid (GCF) among patients with healthy periodontium, gingivitis, and various stages of periodontitis, both before and after NSPT. Emphasis was placed on longitudinal studies evaluating IL-35 dynamics in correlation with periodontal parameters, as well as genetic association studies investigating IL-12A and EBI3 gene polymorphisms. IL-35 levels were generally found to be higher in healthy individuals and reduced in periodontitis patients, indicating a possible protective role in maintaining periodontal homeostasis. Following NSPT, IL-35 levels significantly increased, corresponding with clinical improvement and reduced inflammatory burden. Genetic studies revealed variable associations between IL-35 polymorphisms and susceptibility to periodontitis and related systemic conditions, although further research is needed for validation. IL-35 appears to function as a modulator of immune resolution in periodontal disease, with potential utility as a non-invasive biomarker for disease activity and therapeutic response. Its upregulation during periodontal healing supports its role in promoting tissue stabilization. The integration of cytokine profiling and genetic screening may enhance personalized risk assessment and targeted interventions in periodontal care.

Background: The interdental papilla plays a critical role in maintaining both the esthetic and functional integrity of the periodontium. Although the relationship between the papilla presence and the contact point–bone crest distance is well established, the impact of vertical bone defect morphology—common in periodontitis—remains largely unexplored. Aim: To assess the relationship between the loss of interdental papilla height and three site-specific factors—vertical bone defect morphology, probing depth, and papilla base width—in patients with periodontitis. Materials and Methods: Ten periodontitis patients contributing 28 interdental papillae adjacent to vertical bone defects were included. The recorded parameters included probing depth, papilla base width, and loss of papilla height. Intraoperative measurements of defect depth, mesiodistal width, and buccolingual width were also obtained. Patient-level variables, such as age, sex, oral hygiene, and gingival phenotype, were not controlled or included in the analysis, due to the small number of participants and the study’s focus on defect-level characteristics. Spearman’s rank correlation was used due to non-normal data distribution. Results: A moderate positive association was observed between the probing depth and loss of papilla height (ρ = 0.353), approaching but not reaching statistical significance (p = 0.066). Weak, non-significant associations were found with the remaining parameters (p > 0.05). Conclusions: Although no statistically significant associations were found, observed trends may indicate site-specific influences on the loss of papilla height. These preliminary findings highlight the need for further research with larger, well-characterized cohorts to better understand the factors affecting papilla stability in periodontitis.

Periodontitis is a widespread disease, associated with challenges both in its diagnosis and in selecting from various therapeutic approaches, which do not always yield the expected success. This literature review was conducted to explore diverse therapeutic approaches, especially those focused on nanotechnologies, and their potential contribution to the successful modulation of the host’s response. The effects of the existing microbial diversity and the imbalance of key microbial species in contributing to the progression and worsening of the host’s response in periodontitis are well known. It is essential to understand the role of a well-structured treatment plan for periodontitis, providing opportunities for new research and innovative treatment strategies aimed at reducing the impact of periodontitis on oral and overall systemic health. This will be beneficial for dental professionals, enabling them to effectively prevent and treat periodontitis, ultimately improving the overall health and well-being of patients.