Rafael Xavier Erazo Vaca

Background/Objectives: Periodontitis is a chronic inflammatory disease characterized by progressive destruction of the periodontal supporting tissues. Regenerative responses may vary according to patient-related biological characteristics, periodontal defect morphology, the local inflammatory microenvironment, cellular source, biomaterial selection, and delivery strategy. Cell-based regenerative therapies may therefore provide a biological foundation for the future development of personalized periodontal regenerative approaches. This systematic review and meta-analysis evaluated the effectiveness of cell-based therapies for periodontal regeneration and considered how the current evidence may inform future personalized regenerative strategies. Methods: A comprehensive electronic search was conducted in MEDLINE via PubMed, Web of Science, Embase, and the Cochrane Library, with additional searches performed in SciELO and Latindex, in accordance with PRISMA guidelines. Randomized and quasi-randomized controlled clinical trials evaluating cell-based regenerative therapies for periodontal defects were included. The primary outcomes were clinical attachment level (CAL) gain and probing depth (PD) reduction, while radiographic bone regeneration was considered a secondary outcome. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Leave-one-out sensitivity analyses were performed to assess the stability of the pooled estimates. Results: Six clinical trials were included in the qualitative synthesis, and five contributed to the quantitative analysis. Cell-based regenerative therapies showed a small, non-significant effect for CAL gain (SMD = 0.17; 95% CI: −0.12 to 0.45; I² = 0%) and PD reduction (SMD = 0.13; 95% CI: −0.22 to 0.48; I² = 33.0%). Radiographic bone regeneration showed a larger favorable effect, although statistical significance was not reached and substantial heterogeneity was present (SMD = 1.25; 95% CI: −0.08 to 2.58; I² = 88.2%). Leave-one-out analyses did not materially alter the non-significant interpretation for CAL or PD, although some variation in effect magnitude and direction was observed. Radiographic bone regeneration was more sensitive to the exclusion of individual studies. Overall, superiority of cell-based regenerative therapies over control interventions was not demonstrated. Risk-of-bias assessment indicated a low overall risk for most randomized trials, with some concerns in one trial and moderate risk in the quasi-randomized study. Conclusions: Cell-based regenerative therapies showed preliminary but inconclusive signals of benefit for periodontal regeneration. However, no statistically significant superiority over control interventions was demonstrated for CAL gain, PD reduction, or radiographic bone regeneration. Further well-designed clinical trials are required before these approaches can be considered for routine or personalized periodontal regenerative strategies.

Background: Periodontitis and oral dysbiosis have been linked to systemic inflammation and carcinogenesis. Among oral pathogens, Porphyromonas gingivalis (Pg) and Fusobacterium nucleatum (Fn) are biologically plausible contributors to colorectal cancer (CRC) via inflammatory and immunomodulatory pathways. However, the magnitude and consistency of these associations remain uncertain. Objective: To evaluate whether periodontitis and key oral pathogens are associated with CRC risk and prognosis through a systematic review, meta-analysis, and trial sequential analysis (TSA). Methods: We searched PubMed, Scopus, and Web of Science from inception to December 2024 following PRISMA 2020. Eligible observational studies assessed periodontitis exposure or detection of oral bacteria in relation to CRC incidence or survival. Effect estimates (RRs/HRs) were log-transformed and pooled using random-effects models; heterogeneity was quantified with I². TSA was conducted to appraise information size and the stability of the primary association. Risk of bias was evaluated with ROBINS-I/QUIPS as appropriate. PROSPERO: CRD420251168522. Results: Five studies evaluating periodontitis/oral-pathogen exposure and CRC incidence yielded a 70% higher risk (HR = 1.70; 95% CI: 1.33–2.19; I² = 0%). Detection of Fn was associated with approximately threefold higher risk of CRC (RR = 3.20; 95% CI: 1.76–5.82; p < 0.001). Pg presence was linked to worse overall survival (HR ≈ 2.4; p < 0.01). TSA suggested that the accrued evidence for the primary incidence association is likely sufficient to reduce random errors; nevertheless, interpretability is constrained by the small number of observational studies and between-study differences in exposure and outcome ascertainment. Conclusions: Current evidence indicates that periodontitis and oral pathogens—particularly Fn and Pg—are significantly associated with CRC development and progression. These findings support the clinical relevance of the oral–gut axis and underscore oral health as a potentially modifiable factor in cancer prevention. Further large, well-designed prospective cohorts and mechanistic studies are warranted to strengthen causal inference.

Este artículo examina la eficacia de diversos modelos de evaluación para la acreditación en la gestión de la calidad educativa, centrándose en la identificación de enfoques innovadores que aseguren la excelencia académica en el ámbito de la educación superior. A través de una revisión crítica de la literatura y el análisis comparativo de diferentes modelos, se destacan las mejores prácticas y se proponen recomendaciones para la mejora continua. "La implementación de modelos de acreditación efectivos es crucial para asegurar que los programas educativos cumplan con altos estándares de calidad" (Tutasi, 2022). Los hallazgos indican que los modelos que incorporan autoevaluación y participación activa de las partes interesadas son más eficaces para promover la mejora continua y adaptarse a las demandas cambiantes del entorno educativo.