Artur Pitułaj

Background: This case report documents selective explantation in advanced peri-implantitis, early clinical healing, and exploratory blood and retrieval observations. Methods: A 71-year-old woman with hypertension had radiographic peri-implant bone defects around six mandibular implants. Implants 35 and 42 had evidence of suppuration, probing depths up to 8 mm, clinical mobility, and bone loss exceeding 66% at one or more surfaces, including full-length mesial defects, and were removed. Treatment combined professional hygiene and mechanical debridement, explantation, curettage, adjunctive Er:YAG irradiation of the post-explantation defect walls, chlorhexidine, systemic amoxicillin, and supportive care. The first blood sample was collected on the day of surgery, 2 weeks after the initial hygiene consultation. A second sample was obtained at 6 weeks, while four implants with radiographic defects remained in situ. Results: Both explantation sites showed uncomplicated soft-tissue healing over 2 months; no osseous healing outcome was assessed. At 4 months, the retained implants showed no bleeding on probing, suppuration, or clinically detectable mobility, without establishing long-term disease control. The blood findings were descriptive observations from one patient and showed no consistent downward inflammatory pattern. Ex vivo scanning electron microscopy with energy-dispersive X-ray spectroscopy (SEM/EDS) was performed on implant 35. Conclusions: SEM/EDS analysis of the retrieved implant revealed surface alterations consistent with mechanical wear and localized variations in elemental composition, providing additional insight into the structural and chemical characteristics of an implant affected by advanced peri-implantitis. Blood-derived inflammatory markers may offer complementary information about the patient’s general systemic inflammatory status and contribute to a more comprehensive clinical assessment. However, their specific diagnostic and prognostic value in peri-implantitis remains to be established through larger prospective clinical studies.

Phospholipase A2 (PLA2) enzymes participate in lipid metabolism and inflammatory signaling, but the expression of individual PLA2-family genes in peri-implantitis remains poorly characterized. This exploratory study compared the expression of PLA2G7, PLA2G4A, PLA2G6, and PLA2G12A in paired gingival samples from 19 patients with advanced peri-implantitis requiring implant removal. Inflamed tissue and clinically non-inflamed local reference tissue were collected adjacent to the same affected implant. Gene expression was assessed by quantitative reverse transcription polymerase chain reaction and normalized to on glyceraldehyde-3-phosphate dehydrogenase (GAPDH). Paired expression differences were evaluated using Wilcoxon signed-rank tests with Benjamini–Hochberg adjustment. Complete paired data were available for 19 patients for three genes and 18 patients for PLA2G4A. PLA2G7 expression was higher in inflamed tissue in 15 of 19 patients, with a median fold change of 5.86 (interquartile range, 1.29–17.36; adjusted p = 0.0247). No significant paired differences were detected for the other three genes. In comparisons across genes, the fold change for PLA2G7 exceeded that for PLA2G12A after Holm adjustment, but did not differ significantly from those for PLA2G4A or PLA2G6. These findings suggest an association between advanced peri-implantitis and increased tissue-level PLA2G7 expression. Further studies are needed to establish its functional significance and confirm these preliminary findings.

Background: This exploratory study assessed the frequency of study-defined focal low-trabeculation/low-density intramedullary findings (FLDIFs) in a selected clinical cohort referred for cone-beam computed tomography (CBCT) and examined their associations with demographic, systemic, and radiographic variables. CBCT depicts mineralized trabecular architecture and relative attenuation but cannot directly demonstrate marrow fat or establish osteonecrosis; FDOJ/MFI were therefore considered only possible interpretations rather than imaging diagnoses. Methods: A single-center retrospective analysis included 1000 adults whose CBCT examinations met the study image-quality and anatomical-coverage requirements. FLDIF was defined as a descriptive radiological phenotype and was not considered a diagnosis of fatty degenerative osteonecrosis of the jaw (FDOJ), marrow fatty infiltration (MFI), or another specific disorder. Patients were classified as positive when at least one study-defined finding was present; one largest index finding per positive patient was used for finding-level analyses. Results: FLDIFs were identified in 452/1000 patients (45.2%; 95% CI: 42.1–48.3%) within this CBCT-referred cohort. Age was associated with finding presence in the multivariable model (OR 1.015 per year, 95% CI: 1.006–1.025; p = 0.001). Diabetes mellitus also showed an adjusted association (OR 1.647, 95% CI: 1.022–2.686; p = 0.042), which should be regarded as exploratory because of residual confounding and retrospective disease ascertainment. Panoramic radiographs were available for all 452 index findings; 180 (39.8%) were judged visible and 272 (60.2%) not visible. Visible index findings were larger (median 9.2 vs. 8.1 mm; pFDR = 0.003; |rank-biserial r| = 0.19), whereas the relative CBCT gray-scale comparison was not significant after FDR correction. Most index findings (412/452, 91.2%) were located in the mandibular retromolar regions. Conclusions: The 45.2% value represents the frequency of a study-defined, nonspecific radiological phenotype within a selected CBCT-referred cohort and should not be interpreted as population prevalence or as the prevalence of histopathologically confirmed FDOJ/MFI. The findings are hypothesis-generating; they do not establish a screening indication for CBCT based on age or diabetes. The biological and clinical significance of the imaging phenotype remains uncertain and requires external validation in independent cohorts and, when clinically indicated, histopathological or complementary imaging correlation.

Background: Peri-implantitis is a chronic condition that reflects an interaction between local tissue destruction, systemic inflammation and corrosion-related implant alterations. This preliminary prospective exploratory clinical study aimed to characterize the systemic cytokine profile of patients with advanced peri-implantitis requiring explantation and to explore associations between clinical severity, cytokine behavior and scanning electron microscopy/energy-dispersive X-ray spectroscopy (SEM/EDX)-defined corrosion-related findings. Methods: Thirteen patients with active advanced peri-implantitis were included. Probing depth and cone-beam computed tomography (CBCT)-based bone loss were assessed at four implant surfaces. Peripheral blood was collected before and 4 weeks after explantation. Serum interleukin-1 beta (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), interleukin-12p70 (IL-12p70), tumor necrosis factor alpha (TNF-α), high-sensitivity C-reactive protein (hsCRP), and fibrinogen were analyzed. Explanted implants underwent SEM/EDX assessment and were classified according to the presence or absence of SEM/EDX-defined corrosion-related findings. Results: IL-6 showed the strongest and most consistent associations with clinical and radiographic severity, whereas hsCRP and fibrinogen were not similarly related. Cytokines did not show a uniform post-explantation decrease after explantation. SEM/EDX-defined corrosion-related findings were not associated with higher baseline cytokines, but exploratory subgroup analysis suggested a divergent TNF-α trajectory. Conclusions: These findings suggest that IL-6 may reflect the clinical inflammatory burden of advanced peri-implantitis, while corrosion-related findings may be associated with post-explantation TNF-α behavior. Larger controlled studies are required.

Radiological classification systems are widely used to estimate the difficulty of mandibular third molar extraction, yet their ability to predict patient-centered outcomes remains uncertain. This study investigated whether radiological predictors of surgical difficulty are associated with prolonged operative time and increased postoperative pain, and whether the association between radiological parameters and postoperative pain changes after adjustment for operative time. In this exploratory secondary analysis of a randomized clinical trial, 122 patients undergoing mandibular third molar extraction were evaluated using the Winter and Pell–Gregory classifications and the Pederson difficulty index. Surgical duration was recorded, and postoperative pain was assessed during the early postoperative period using a numeric rating scale. Multivariable regression analyses were applied to identify independent predictors of operative time and postoperative pain. Horizontal and mesioangular impactions were associated with significantly longer operative times. Surgical duration was independently associated with higher postoperative pain (β = 0.03 per minute; R² = 0.22). Importantly, radiological parameters were no longer significant after adjustment for operative time. These findings indicate that the association between radiological complexity and postoperative pain is not independent of operative time and should be interpreted as reflecting shared variance between these factors rather than a direct relationship.

Background/Objectives: This study evaluated autologous platelet concentrates (APCs), including advanced platelet-rich fibrin (A-PRF+) and concentrated growth factors (CGFs), as biologically active matrices, and photobiomodulation (PBM) as a biophysical stimulus affecting soft and hard tissue regeneration following mandibular third molar extraction. Methods: A six-arm parallel randomised controlled trial was conducted including 135 patients. A total of 122 participants completed follow-up and were analysed: control (n = 22), photobiomodulation (n = 20), A-PRF+ (n = 19), CGF (n = 20), A-PRF+ plus photobiomodulation (n = 22), and CGF plus photobiomodulation (n = 19). The primary endpoint was postoperative pain intensity assessed on postoperative day 3 using an 11-point visual analogue scale (VAS). Secondary outcomes included swelling, trismus, wound healing assessed by the early healing index, and bone regeneration assessed by CBCT-based fractal dimension analysis at 4 months. Results: On postoperative day 3, mean VAS pain was 2.95 ± 2.65 in the control group and 1.00 ± 1.65 in the photobiomodulation group, corresponding to a mean difference of 1.95 VAS points. The overall between-group difference for day 3 pain was statistically significant. In swelling outcomes, no statistically significant between-group differences were observed at days 1, 3, or 7 across facial measurement lines. In CBCT fractal analysis, a significant group effect was detected for the mid socket region, with higher fractal dimension at 4 months in the CGF plus photobiomodulation group compared with the control. Conclusions: Both APCs and PBM positively influenced postoperative healing. Their combined application, particularly CGF with PBM, showed the most consistent regenerative effects, although not all outcomes differed significantly between groups. These minimally invasive strategies may support soft and hard tissue regeneration.

Fatty degenerative osteonecrosis of the jaw (FDOJ) is a chronic, aseptic inflammatory condition that is characterized by molecular disruptions in bone metabolism and necrotic bone marrow within the jawbone cavities. In contrast to the overt clinical signs typically observed in osteopathies, FDOJ frequently presents with a “silent inflammation” phenotype. The electronic databases PubMed, Scopus, and Embase were searched using appropriate search terms, and the methodology was performed according to PRISMA-ScR guidelines. The elevated expression of inflammatory mediators, particularly C-C motif Chemokine Ligand-5/Regulated on Activation, Normal T Cell Expressed and Secreted (CCL5/RANTES), fibroblast growth factor-2, and interleukin-1 receptor antagonist, distinguishes FDOJ at the molecular level and links it to systemic inflammatory and autoimmune diseases. These immunohistochemical markers play a pivotal role in the pathogenesis of chronic inflammation, immune response regulation, and abnormal bone remodeling. Advanced diagnostic tools, such as conebeam computed tomography and trans-alveolar ultrasonography, facilitate the detection of pathological changes that are not easily discernible with conventional radiography. Surgical intervention remains the primary treatment modality, often complemented by therapies that target these molecular pathways to modulate chronic inflammation. This article underscores the importance of integrating molecular diagnostics, advanced imaging, and clinical data for effective FDOJ detection and management.

Background/Objectives: Despite the increasing popularity of lacto-ovo vegetarian (LOV) diets, their impact on oral wound healing remains underexplored. The aim of this study was to evaluate the potential influence of the LOV diet on soft tissue healing following lower wisdom tooth operation. Methods: This prospective study involved 40 participants equally divided into two groups: the LOV group (lacto-ovo vegetarians for at least seven years) and the control group (general diet). The main inclusion criterion was the need for third molar extraction, while smoking, pregnancy, and systemic diseases that may compromise wound healing were disqualifying factors. Parameters such as wound length, swelling, pain, analgesic use, and bacterial plaque index were assessed on the 3rd and 7th days post-surgery. Results: LOV participants exhibited significantly faster wound healing, with reduced wound length and swelling by the 7th day compared to the control group. Pain levels and analgesic consumption were also lower in the LOV group at the end of the observation period. Although the LOV group had higher trismus on the 3rd day, it normalized by the 7th day. These outcomes may be, apart of the diet type followed, partially attributed to the younger age and shorter surgical time observed in the LOV group. Conclusions: The findings highlight the potential role of dietary interventions in optimizing recovery, warranting further research to confirm these benefits in broader populations.

Autogenous grafts remain the “gold standard” in bone tissue grafting procedures; however, limitations such as donor site morbidity, invasiveness, and limited availability have spurred research into alternative materials. Hydroxyapatite (HA), a widely used bioceramic, is known for its bioactivity and biocompatibility. Nonetheless, its inherent brittleness and porosity necessitate modifications to enhance its mechanical and functional properties. Ionic doping has emerged as a transformative strategy to improve the properties of HA by integrating ions such as strontium (Sr²⁺), magnesium (Mg²⁺), and zinc (Zn²⁺). These dopants influence HA’s crystal structure, morphology, and solubility, resulting in enhanced bioactivity, accelerated bone mineralization, and improved mechanical properties, such as increased fracture resistance and wear durability. Additionally, antimicrobial properties can be achieved through the inclusion of silver ions (Ag⁺), reducing the risk of peri-implant infections. This review focuses on the effects of ionic doping on the structure and functionality of hydroxyapatite, emphasizing advancements in tailoring its properties to clinical needs. By consolidating two decades of research, this study highlights how ionic doping bridges the gap between synthetic biomaterials and native bone, unlocking new potential in regenerative medicine and orthopedic applications.

Tooth extractions, especially of impacted lower third molars, are among the most common procedures performed in dental practices. The continuity of the patient’s oral mucosa, which is interrupted during them, can manifest itself in general discomfort, pain, swelling, and even trismus. In the age of cosmetic dentistry, when lost teeth are restored through implant, prosthetic, and orthodontic treatment, each tooth extraction actually reduces the amount of available alveolar bone. This has prompted researchers to develop extraction sockets treatment procedures that reduce the negative consequences of surgical intervention while also enhancing the rate of alveolar bone and soft tissue regeneration using minimally invasive approaches. This is expected to enable or significantly facilitate further stages of treatment. The aim of this paper is to review the literature on the use of autologous blood preparations, which are considered to aid regenerative processes when applied to extraction sockets.