Hector Alfredo Lema Gutierrez

Background: Palatal graft harvesting can cause pain, bleeding, and delayed healing, with postoperative recovery varying across patients and over time. Topical hyaluronic acid (HA) may reduce donor-site morbidity and promote tissue repair. Identifying the postoperative time points and clinical domains in which HA may provide benefit could support more informed, patient-centered postoperative management. Objective: To evaluate the time-specific effects of topical HA on palatal wound healing and postoperative morbidity after autogenous gingival graft harvesting and to examine their clinical implications for postoperative care. Methods: Randomized clinical trials comparing topical HA with placebo, no application, or standard care were reviewed. Separate random-effects meta-analyses were performed at each postoperative time point using risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes. Between-study variance was estimated using REML. Leave-one-out, Hartung–Knapp, and formulation-based sensitivity analyses were performed. Risk of bias was assessed using RoB 2, and certainty of evidence using GRADE. Results: Eight randomized trials were included. HA increased complete epithelialization at day 14 (RR = 2.11; 95% CI, 1.13–3.94) and day 21 (RR = 1.62; 95% CI, 1.29–2.03). WHI favored HA at day 7 (MD = 0.58; 95% CI, 0.42–0.75). Pain reductions at days 3 and 7 and bleeding reductions at days 1 and 3 were not statistically significant. Analgesic consumption was lower at day 3 (MD = −0.80; 95% CI, −1.34 to −0.26), while color match favored HA at days 14 and 21. Hartung–Knapp analyses increased uncertainty for WHI, pain, and color match. No result was rated at high overall risk of bias; certainty ranged from low to very low. Conclusions: Topical HA appears to provide its most consistent benefit in accelerating palatal epithelialization and selected healing outcomes rather than uniformly reducing all dimensions of postoperative morbidity. These time- and outcome-specific effects may inform patient-centered and risk-adapted postoperative strategies, particularly when early wound closure is a clinical priority. However, the current aggregate evidence does not permit identification of individual treatment responders. Future adequately powered randomized trials incorporating standardized HA formulations, patient-level characteristics, potential effect modifiers, and harmonized outcome assessment are needed to support precision treatment selection.

Background: Periodontitis is a chronic inflammatory disease characterized by progressive destruction of the tooth-supporting tissues and may substantially impair oral health-related quality of life (OHRQoL). Although the clinical consequences of periodontitis are well documented, the extent to which disease severity is associated with patient-reported outcomes remains insufficiently understood. This study aimed to evaluate the association between periodontitis severity and OHRQoL and to examine sociodemographic, behavioral, and systemic factors associated with poorer OHRQoL. Methods: A cross-sectional analytical study was conducted among 136 adult patients diagnosed with stage II or stage IV periodontitis at the Periodontology Clinic of Universidad Tecnológica de México (UNITEC). OHRQoL was assessed using the Oral Health Impact Profile for Periodontal Disease (OHIP-14-PD). Sociodemographic characteristics, smoking status, and diabetes mellitus were recorded using a structured questionnaire. Periodontal status was determined through standardized clinical and radiographic examinations. The internal consistency of the OHIP-14-PD was evaluated using Cronbach’s alpha coefficient. Bivariate analyses were performed using non-parametric tests. An exploratory, partially adjusted multivariable linear regression model including sex, marital status, diabetes mellitus, and periodontitis stage was also performed. Results: Stage IV periodontitis was more prevalent than stage II periodontitis (55% vs. 45%). The mean OHIP-14-PD score was 24.9 ± 13.7, and the instrument demonstrated excellent internal consistency (Cronbach’s α = 0.89). Patients with stage IV periodontitis had significantly higher OHIP-14-PD scores than those with stage II disease (30.1 ± 12.4 vs. 18.6 ± 12.6; p < 0.001), indicating poorer OHRQoL. In the bivariate analyses, poorer OHRQoL was also observed among current smokers, participants with diabetes mellitus, those with lower educational attainment, and those with lower socioeconomic status (p < 0.05). In the exploratory partially adjusted model, male sex (β = 4.2; 95% CI: 0.1–8.2; p = 0.042), diabetes mellitus (β = 6.5; 95% CI: 2.1–10.9; p = 0.004), and stage IV periodontitis (β = 4.6; 95% CI: 0.4–8.7; p = 0.031) were associated with higher OHIP-14-PD scores. Conclusions: In this single-center cross-sectional sample, patients with stage IV periodontitis reported higher OHIP-14-PD scores than those with stage II periodontitis. These findings indicate an association within the studied clinical population and should not be interpreted as evidence of a causal effect or as directly generalizable to broader populations. Larger multicenter longitudinal studies including patients across all periodontitis stages are required to confirm the magnitude and external validity of this association.

Background: Osteoradionecrosis (ORN) is a severe late complication of radiotherapy for head and neck cancer, associated with impaired bone healing, infection, pain, and exposed bone. Periodontal disease may contribute to ORN by maintaining inflammatory and infectious foci within irradiated tissues with reduced vascularity and repair capacity. Objective: To evaluate whether periodontal disease or poor periodontal status is associated with increased ORN risk in patients with head and neck cancer undergoing radiotherapy. Methods: This systematic review and meta-analysis followed PRISMA 2020 recommendations and was structured according to the PECO framework. Searches were conducted in PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, ClinicalTrials.gov, WHO databases, and gray literature. Observational studies involving head and neck cancer patients treated with radiotherapy and reporting periodontal status in relation to ORN were included. Risk of bias was assessed using a domain-based approach. Random-effects models estimated pooled relative effect estimates and ORN prevalence. Results: Six studies were included in the primary association meta-analysis. Periodontal disease was significantly associated with increased ORN risk, with a pooled relative effect estimate of 4.83 (95% CI: 1.96–11.93; p = 0.0006; I² = 50.4%). Seven studies including 1785 patients and 118 ORN events were included in the prevalence meta-analysis, showing a pooled ORN prevalence of 9% (95% CI: 6–13%; I² = 78.0%). Conclusions: The findings suggest that periodontal disease or poor periodontal status may be associated with an increased likelihood of ORN in patients with head and neck cancer undergoing radiotherapy. Given the observational nature of the evidence and the moderate between-study heterogeneity, this association should be interpreted cautiously. Comprehensive periodontal assessment and long-term oral surveillance may be considered as components of multidisciplinary care before and after radiotherapy.