Alessandro Zangani

Background: Gingival recession (GR) is defined as the exposure of the root surface due to the gingival margin shifting apically from the cemento-enamel junction. Current effective management of defects related to GR relies on root coverage periodontal plastic surgery (RCPPS), using the Modified Coronally Advanced Flap (mCAF) with an envelope design. Recent literature also reported the association of different biomaterials to the mCAF procedure. In light of these considerations, a systematic review (SR) was conducted to determine and compare the efficacy of all mCAF adjunctive techniques for the treatment of multiple adjacent GR-type (MAGR) defects. Methods: An electronic search was conducted in 2025 on studies published between 2013 and 2025, using PubMed, Scopus, Web of Science, and Cinahl Complete, to address the focused question: “which is the efficacy of different mCAF adjunctive techniques for the treatment of multiple adjacent GR-type defects, in terms of root coverage (RC), esthetic outcomes, and keratinized tissue (KT) augmentation?”. Randomized controlled trials with a minimum follow-up of 6 months with ≥ 5 patients treated for coverage of MAGR were included. Risk of bias was assessed with RoB 2 Tool. A meta-analysis was performed using RevMan5.4 software and the level of evidence of included studies was analyzed with GRADEPro GDT. Results: A total of 17 studies were included in the SR, 9 of which evaluating mCAF + sCTG (subepithelial connective tissue graft) vs. mCAF adjunctive techniques [Collagen Matrix (CM), xenogeneic acellular dermal matrix (XADM), Platelet-Rich Fibrin (PRF), Enamel Matrix Derivatives (EMD), sCTG harvested double blade scalpel] were then included in the meta-analysis. The primary outcomes of complete root coverage (CRC) and keratinized tissue width variation (ΔKTW) were statistically significant ([CRC: Odds Ratio (OR) 1.70; 95% CI (confidence interval) 1.18, 2.44; p = 0.004]; [ΔKTW: SMD (standardized mean difference) 0.37; 95% CI 0.11, 0.63; p = 0.005]) in favor of mCAF + CTG. Meanwhile, no statistically significant difference was observed in terms of RES. The certainty assessment highlighted relevant results: despite the lack of evidence in the long-term, a high level of evidence showed that sCTG was more effective than XADM in terms of CRC (p = 0.002) and ΔKTW (p = 0.0001). A low level of evidence revealed that sCTG achieved a greater ΔKTW compared to CM (p = 0.0006). Although no significant differences were observed, a low level of evidence suggested that mCAF + EMD and mCAF + sCTG (DBS) may provide good results. To date, only one RCT showed long-term stable results of CTG in terms of RC. Conclusions: The association of sCTG to mCAF demonstrated better results in terms of RC and KTW augmentation in short- and medium-term follow-ups. Long-term studies are needed to confirm the efficacy of the other mCAF adjunctive techniques, considering limitations due to heterogeneity in follow-ups, distribution of techniques analyzed, and different study designs. Registration in PROSPERO (International prospective register of systematic reviews) was performed with ID CRD420251085823.

The extraction of impacted mandibular third molars is a common oral surgical procedure often associated with postoperative conditions, including pain, edema, trismus, and inferior alveolar nerve (IAN) injury. In recent years, the introduction of advanced technologies, namely piezoelectric surgery and artificial intelligence (AI), has transformed diagnostic and surgical approaches, offering new possibilities to enhance safety, precision, and treatment outcomes. A narrative review was conducted by searching PubMed (Medline) for relevant studies published between January 1, 2015, and January 31, 2025. The search followed the PCC framework and was complemented by manual exploration through Google Scholar. The PRISMA 2020 statement was followed to select the included studies. A total of 58 records were identified through electronic and manual searches. No duplicates were identified, and no records were excluded before screening; therefore, 58 records were screened. Following title and abstract screening, 23 articles were assessed for full-text eligibility. Of these, seven were excluded, resulting in 7 studies being included in the final review. The reviewed studies highlight that artificial intelligence enables accurate and predictive assessment of the anatomical relationship between impacted third molars and critical anatomical structures, particularly the inferior alveolar nerve. Concurrently, piezoelectric surgery demonstrates clear advantages over conventional rotary instruments by reducing postoperative complications and enhancing both patient comfort and bone healing. The diagnostic performance of artificial intelligence varies based on the type of imaging data provided, the design of the deep learning model, and the use of semantic annotation. While AI can match expert-level accuracy on panoramic radiographs, particularly when semantic segmentation is employed, its most valuable role may be in identifying cases that would benefit from CBCT imaging, rather than replacing advanced imaging altogether. Piezoelectric techniques, on the other hand, offer a safer and more conservative surgical alternative, contributing to reduced morbidity and improved clinical outcomes. Surgical Navigation serves as a valid tool, but its applicability remains limited to selected cases due to increased costs and operating times. Overall, the integration of these technologies represents a step forward toward safer, more personalized, and minimally invasive approaches in third molar surgery.

Oral candidiasis is a common condition in immunocompromised patients, such as those with HIV and diabetes. It manifests in acute forms, for example, pseudomembranous candidiasis and erythematous candidiasis, as well as in chronic forms, including chronic hyperplastic candidiasis and prosthesis-induced candidiasis. The aim of this article is to provide an overview of oral candidiasis manifestations and treatment, and to highlight the importance of appropriate management of the disease in immunocompromised patients. The authors conducted a literature review on oral candidiasis to summarize clinical information and treatment indications. Median rhomboid glossitis, once considered a congenital malformation, is now recognized as a form of chronic candidiasis. Angular cheilitis is often caused by mixed infections with Candida and Staphylococcus aureus, particularly in the elderly population. Antifungal agents used in treatment include polyenes (nystatin and amphotericin B) and azoles (fluconazole and itraconazole), which act by inhibiting ergosterol biosynthesis in fungi. Antiretroviral therapy showed beneficial effects in reducing oral candidiasis in HIV-positive patients. In patients undergoing radiation therapy for oral carcinoma, the risk of candidiasis is increased, requiring preventive measures, such as proper oral hygiene and local antifungal therapies. Early diagnosis and targeted treatment are essential for managing oral candidiasis, especially in at-risk patients. A personalized therapeutic approach is crucial for reducing complications and preventing the malignant progression of such an unpleasant infection.

Background/Objectives. With a rapid palatal expander (RPE) is reported to be effective in increasing the volume of nasal cavities, with a restoration of physiological nasal airflow. The purpose of this retrospective clinical study was to evaluate, using Cone Beam Computed Tomography (CBCT), the volumetric changes and airflow velocity changes in the nasal cavities, retro-palatal and retro-glossal airways, resulting from the use of RPE with dental anchorage (group A), also comparing these data with patients non treated with RPE (group B). Methods. Sixteen subjects (aged 9.34 years) with transverse maxillary deficiency and unilateral posterior crossbite were treated with RPE with dental anchorage. Additionally, 8 patients (aged 11.11 years) with juvenile idiopathic arthritis, who did not undergo any orthodontic treatment, were selected as a control group. Expansion was performed until overcorrection was achieved, and the device was left in place for 6 months as fixed retention, followed by another 6 months of night-time removable retention. From the retrospective evaluation, all patients presented two CBCT scans at baseline (T0) and 1-year follow-up (T1). The 3D-Slicer software was used for each CBCT to measure the nasal (VN), retropalatal (VRP), and retroglossal (VRG) volumes, while an iterative Excel spreadsheet allowed for a pilot approximated modeling and calculation of airway flow-related data. Results. Regarding mean age, a statistically significant difference (p = 0.01 *) was found between groups, suggesting that group B is closer to the pubertal growth peak. Analysis between T0 and T1 revealed: (i) a statistically significant increase for volumes VN, VRP and VRG in group A; (ii) a statistically significant increase for VN in group B; (iii) a statistically significant decrease for all variables related to airflow velocity in both groups. Furthermore, comparison between group A and B, regarding variations between T0 and T1, found a statistically significant difference only for VN. Conclusions. Within the limitations of this pilot evaluation, the treatment with RPE revealed promising outcomes for retro-palatal, retro-glossal and nasal volumes, together with clinical changes in airflow velocities.

Background: As the rehabilitation of the upper anterior maxilla primarily requires high predictability of successful aesthetic outcomes, procedures of immediate implant placement are frequently employed. The aim of this pilot study was to retrospectively evaluate the short-term outcomes of a protocol of immediate implant placement in fresh extraction sockets, followed by immediate non-functional provisional restorations. Methods: Patients were treated for the replacement of maxillary central or lateral incisors, or cuspid teeth with a single-crown locking-taper implant. Clinical and photographic records were retrospectively compared between the teeth prior to extraction (T0) and restorations one year after prosthetic loading (T1). Outcomes were analyzed using the Pink Esthetic Score (PES), according to the patient’s phenotype (thin/thick), with or without the use of connective tissue graft (CTG). Results: The overall mean PES of 25 implants treated was 9.24 ± 2.36 at T0 and 9.60 ± 1.70 at T1. Comparison of groups between T0 and T1 revealed significant PES variations (p = 0.04), with the best and the worst scores, respectively, registered for thin + CTG group (from 7.50 ± 1.91 to 9.75 ± 2.87) and thin group (from 11.33 ± 2.33 to 10 ± 0.89); moderate increases were assessed for thick group (from 8.44 ± 2.40 to 9.44 ± 2.12) and thick + CTG group (from 9.50 ± 1.04 to 9.33 ± 0.81). Conclusions: Within the limits of a short-term analysis of a small number of patients, immediate implant rehabilitation for aesthetic areas of the upper maxilla can be assumed as a safe and predictable protocol. Concomitant use of CTG seems to provide beneficial effects in thin phenotypes, not any additional value in thick phenotypes.

Pain management in endodontics is a critical aspect of dental care, as the fear of endodontic pain often influences patient behavior and treatment outcomes. This narrative review examines the mechanisms, classification, and management strategies for pain associated with endodontic procedures, focusing on preoperative, intraoperative, and postoperative stages. Preoperative pain, often caused by irreversible pulpitis or periapical infections, is exacerbated by inflammatory mediators like prostaglandins, which lower pain thresholds and hinder anesthetic efficacy. Intraoperative pain arises from difficulties in achieving adequate anesthesia, particularly in cases of pulpitis, while postoperative pain, peaking within 24 hours, is linked to inflammatory responses in periapical tissues. A range of pharmacological options is discussed, including NSAIDs, paracetamol, corticosteroids, and opioids, alongside their mechanisms of action, efficacy, and side effects. NSAIDs remain the first-line treatment due to their anti-inflammatory and analgesic properties, with ibuprofen demonstrating rapid and effective pain relief. Corticosteroids are highlighted for their ability to enhance anesthetic success and reduce inflammation, particularly in severe cases. Opioids and gabapentinoids are reserved for more severe or neuropathic pain, with cautious use due to potential dependency risks. The aim of this review is to emphasize the importance of tailored analgesic strategies that address the specific pain phase, patient characteristics, and procedural requirements. This comprehensive approach not only alleviates pain but also enhances the overall effectiveness of endodontic treatment, ensuring better patient outcomes and satisfaction.

Background: The aim of this retrospective study was to compare the histomorphometry of post-extractive sites previously grafted with deproteinized bovine bone, with or without the association of a calcium sulphate preparation. Methods: The retrospective evaluation comprehended patients previously selected and treated for the extraction of one or more mono-radicular teeth, followed by an implant-prosthetic rehabilitation. Post-extractive sites had been randomly assigned to test or control group, respectively, if deproteinized bovine bone was used in association with a calcium sulphate preparation or alone. In both cases, a collagen membrane was employed to cover the grafted area. After four months, a biopsy of regenerated bone was taken from all grafted sites and then processed for histomorphometric analysis. Results: Of 24 samples analyzed 4 months after extraction, vital bone was present in 62.5% of cases for the test group and in 31.25% for the control group. Acellular bone was respectively found in 5% of cases for the test group and in 32.91% for the control group. Both these differences were statistically significant (p < 0.05) between groups. Conclusions: Calcium sulphate in association with deproteinized bovine bone seems to promote proper vital bone formation, with less acellular bone compared to deproteinized bovine bone used alone. Socket preservation procedures with the use of specific osteoconductive materials improve the maintenance of width and height of remaining bone. Findings of the present study offer clinicians a predictable protocol for preserving vital bone in early healing of post-extraction sites, slowing down the resorption process at the same time.

This study aimed to assess the impact of on oral health in oncological patients. A Prevention Dental Hygiene Project was conducted in the Day-Hospital Oncology Unit. Fourteen patients who satisfied the inclusion criteria at their first visit were enrolled voluntarily. Their oral health conditions were evaluated using the Bleeding on probing (BoP), Visible Plaque Index (VPI) at the initial stage (T0), one month (T1), and two months after (T2) The results showed an improvement in inflammatory and plaque indices in patients who attended all visits and followed the instructions provided. In conclusion, the dental project implemented on frail patients highlights the significance of preventive measures and the value of multidisciplinary collaboration in the field of medicine.

Background. Transparent aligners are recently introduced orthodontic devices considered promising for the improvement of oral health conditions, in terms of faster treatment times and enhanced comfort, especially if compared with traditional fixed orthodontic therapy. This systematic review aimed to evaluate at-home protocols for proper oral hygiene and aligners cleaning during orthodontic treatment. Methods. A search was conducted using the following four databases: PubMed, Cochrane Library, Web of Science, and Scopus. The systematic review (registered as CRD 42024562215) followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and included prospective studies, randomized controlled trials (RCTs), controlled clinical trials, and in vivo and ex vivo studies; they had to assess treatment with invisible orthodontics compared to treatment with fixed orthodontics, home oral hygiene, or aligner disinfection protocols. The evidence in the studies was evaluated for risk of bias using the RoB-2 (for RCTs and randomized crossover studies) and ROBINS-I tools (for observational studies). Results. Eleven studies were included in this systematic review: four RCTs, four crossover studies, and three cross-sectional observational studies. Seven studies considered patients undergoing orthodontic treatment, whereas four examined orthodontic aligners. The cleaning protocols of the aligners were evaluated based on the analysis of residual biofilm on the thermoplastic surfaces. Studies included were characterized by a low level of certainty, thus further evidence is needed. Conclusions. The most effective protocols entailed a combination of mechanical and chemical agents, suggesting that it is fundamental for patients undergoing aligner treatment to focus on individually tailored home oral hygiene protocols.

Background: to evaluate the effectiveness of different topical agents in biofilm disaggregation during non-surgical periodontal therapy. Methods: the search strategy was conducted according to the PRISMA 2020 on Pubmed, Cochrane Library, Scopus, and Web of Science, and it was registered in PROSPERO, ID: CRD42023474232. It included studies comparing non-surgical periodontal therapy (NSPT) with and without the application of topical agents for biofilm disruption. A risk of bias analysis, a qualitative analysis, and a quantitative analysis were performed. Results: out of 1583 records, 11 articles were included: 10 randomized clinical trials and one retrospective analysis. The total number of participants considered in the 11 articles included in the study was 386. The primary outcomes were probing pocket depth (PPD), clinical attachment level (CAL), and bleeding indices. The secondary outcomes were plaque indices, gingival recessions, and microbiological parameters. The meta-analysis revealed the following: [Weighted mean difference (WMD): −0.37; 95% confidence interval (CI) (−0.62, −0.12), heterogeneity I²: 79%, statistical significance p = 0.004]. Conclusions: the meta-analysis of probing pocket depth reduction (PPD) between baseline and follow-up at 3–6 months showed a statistically significant result in favor of sulfonated phenolics gel. The scientific evidence is still limited and heterogeneous; further randomized clinical trials are required.