Amalia Syrioti

Background/Objectives: Bullous pemphigoid (BP) in children is a rare autoimmune subepidermal blistering condition that shows significant clinical variability depending on age. This narrative review summarizes the available literature on the epidemiology, etiology, clinical manifestations, diagnosis, management, outcomes, and future perspectives of pediatric BP. Methods: A search of the PubMed/MEDLINE and Scopus databases from their inception to July 2026 was conducted for English-language articles on BP in patients younger than 18 years old. After record screening and full-text assessment, 55 publications were selected and narratively synthesized. Results: Infants with BP frequently present with acral and palmoplantar blistering, whereas older children and adolescents show more heterogeneous clinical manifestations. BP180 is the principal autoantigen, although antigenic heterogeneity has been reported. Diagnosis requires integration of clinical, histopathological, and immunopathological findings. Linear IgG and/or C3 deposition along the basement membrane zone on direct immunofluorescence (DIF) is an important but non-specific finding. Salt-split skin testing and antigen-specific serology may assist in distinguishing BP from other autoimmune subepidermal blistering diseases. Corticosteroids are the most frequently reported initial treatment, while dapsone and other steroid-sparing agents have been used in selected patients. Intravenous immunoglobulin (IVIG), immunosuppressants, and targeted therapies have primarily been reported in refractory cases, with evidence derived predominantly from case reports and small series. Conclusions: The prognosis reported in the pediatric literature is generally favorable, although there are some reports of resistant or recurrent cases. However, relapse rates in the long-term are not known. There is a need for multicenter prospective trials and standardization of outcomes.

Background: Effective management of peri-implant disease relies primarily on mechanical removal of the bacterial biofilm. However, achieving adequate surface decontamination can be challenging due to complex implant-surface morphology and restricted access to deep peri-implant pockets. This has prompted the use of adjunctive antimicrobial agents to complement mechanical therapy and improve therapeutic outcomes. Objective: To investigate whether the adjunctive use of antimicrobial strategies improves clinical, microbiological, and radiographic outcomes in patients with peri-implant mucositis and peri-implantitis. Materials and Methods: A structured narrative review was conducted using PubMed/MEDLINE and Scopus in July 2026. No database filters concerning language, human participants or study design were applied. During the screening process, only randomized controlled clinical trials involving human participants and available as English-language full texts were selected. Eligible interventions included locally or systemically administered antibiotics, antiseptics, antimicrobial drug-delivery systems, antimicrobial photodynamic therapy (aPDT), ozone-based therapies, and microbiome-modulating adjuncts. Conventional laser therapy was not classified as an eligible antimicrobial intervention. The database searches retrieved 462 records, including 252 from PubMed and 210 from Scopus. Following duplicate removal and eligibility assessment, 100 publications representing 93 independent clinical trials were included. Results: adjunctive antimicrobial efficacy was highly variable and appeared to depend on disease severity, debridement strategy, antimicrobial agent, delivery modality, and follow-up period. Repeated or sustained local antimicrobial delivery was associated with modest, short-term benefits in several studies, whereas chlorhexidine (CHX) generally provided limited additional benefit over mechanical therapy. Evidence for systemic antibiotics remained inconsistent and insufficient to support routine use, while aPDT offered potential benefits that varied according to treatment protocol. Ozone therapy, herbal agents, and novel drug-delivery systems yielded encouraging preliminary results, although evidence remains scarce. Moreover, reductions in bleeding and probing depth (PD) did not reliably correspond to superior microbiological outcomes, radiographic bone gain, or complete disease resolution. Conclusions: Mechanical debridement (MD) and effective plaque control remain central to peri-implant disease management. Some adjunctive interventions produced modest short-term improvements in individual studies; however, the available evidence does not demonstrate durable disease control or support routine use. Therapeutic decisions should be tailored to disease severity, patient and implant characteristics, and the balance between potential benefits and antimicrobial-associated risks. Further well-designed and adequately powered randomized controlled trials with extended follow-up periods are needed to establish more definitive recommendations.

Background: Amelogenesis imperfecta affecting enamel formation is frequently associated with a variety of malocclusions and eruption disturbances. Orthodontic treatment is crucial in comprehensive patient management. Previous studies have shown that orthodontic treatment becomes more challenging in patients with AI as the defective enamel affects the bracket bonding, retention of appliances and treatment mechanics and often needs modified bonding protocols, pre-treatment restorative build-ups, skeletal anchorage and general multidisciplinary management. There is no evidence of the ideal orthodontic treatment yet; available evidence only consists of case reports and small observational studies that address specific aspects with no established consensus. Therefore, this narrative review aimed to critically examine the contemporaneous evidence on orthodontic assessment and treatment planning in AI patients, drawing on studies identified through a structured literature search. Materials and Methods: An electronic search of the literature was conducted in the PubMed, Scopus, and ScienceDirect databases. Out of 640 records that were initially identified, 11 studies met the inclusion criteria for qualitative synthesis. Results: Bonding issues resulting from enamel defects tend to be identified as a significant clinical challenge necessitating modified orthodontic techniques. The included studies demonstrated that by using individualized treatment planning, modified bonding procedures, fixed appliances, expansion procedures, skeletal anchorage and combined orthognathic surgery in some cases within the multidisciplinary treatment approach, there can be successful orthodontic management for these patients. Conclusions: Vital steps such as early diagnosis, careful treatment planning, and coordination with restorative and prosthodontic treatment were associated with better functional and esthetic outcomes. Consequently, even though there is limited evidence, the available literature supports a customized interdisciplinary approach as the most predictable and effective strategy for managing orthodontic problems in patients with AI, while emphasizing that case reports and small observational studies are the main sources of current findings.

Background: Oral potentially malignant disorders (OPMDs) comprise clinically and histologically heterogeneous lesions associated with an increased risk of oral squamous cell carcinoma (OSCC). Histopathological grading of oral epithelial dysplasia (OED) remains central to risk estimation but has limited predictive precision. Podoplanin and selected cancer stem cell (CSC) or stemness-associated markers may capture complementary biological processes involved in progression. Objective: To synthesize evidence on podoplanin and selected CSC or stemness-associated markers as indicators of malignant transformation and risk stratification across a prespecified OPMD spectrum, while distinguishing longitudinal prediction from cross-sectional, diagnostic, and mechanistic evidence. Methods: Three original PubMed searches covered database inception to 13 July 2026. A post hoc recall audit against three key evidence syntheses identified one eligible longitudinal report missed during the initial selection; this report was added by backward citation checking. A broader supplementary sensitivity query was run during revision and reported separately without being merged into the original selection counts. In total, 47 publications were included. Study design, effect measure, threshold provenance, internal validation, and possible cohort overlap were charted and synthesized narratively. Results: Among the biomarkers reviewed, podoplanin had the most developed longitudinal evidence, including a pooled hazard ratio (HR) of 3.72 (95% confidence interval [CI] 2.40–5.76) in one meta-analysis. A separate diagnostic-accuracy synthesis reported sensitivity of 78.9% and specificity of 55.0%, corresponding to a positive likelihood ratio (LR+) of 1.75 and a negative likelihood ratio (LR−) of 0.38. Predictive values varied materially with baseline transformation risk. CD133, BMI1, and ABCG2 showed large associations in individual cohorts, but independent replication and external validation were limited. Cross-sectional expression gradients were not treated as evidence of prospective prediction. Conclusions: Within the defined OPMD scope, podoplanin has the most developed longitudinal evidence, but its predictive values are prevalence-dependent and no marker is sufficiently validated for stand-alone clinical use. Prospective multicenter studies should compare prespecified biomarker models with established clinical, histopathological, and molecular predictors and should evaluate calibration, clinical utility, and external validity before management decisions are altered.