This systematic review, the first in this field, aimed to evaluate if interventions for dentin hypersensitivity (DH) affect patient-reported oral health-related quality of life (OHRQoL). A systematic search was conducted across seven electronic databases and gray literature sources, focusing on interventional studies published from 2010 onward. Eligible studies included adult participants with DH and assessed OHRQoL using validated measures. Data extraction followed the PRISMA guidelines. Risk of bias was appraised using the JBI tool. Thirteen randomized controlled trials involving 616 participants were included. Interventions ranged from desensitizing agents, fluoride varnishes, and laser therapy to nonpharmacological approaches like behavioral techniques. QoL was measured primarily using OHIP-14 and DHEQ-15 tools. The certainty of evidence was rated as very low due to risks of bias, inconsistency, and imprecision. Key findings from this review can help shape the way we understand, quantify, and explore QoL in patients diagnosed with DH. Although several interventions showed promise in reducing DH symptoms and improving QoL, the current evidence base is methodologically limited and inconsistent. High-quality studies using standardized, validated patient-reported outcome measures are needed. Clinical management of DH should incorporate assessment of OHRQoL to guide holistic, patient-centred care.
The present systematic review critically summarizes the results of clinical studies investigating the risk of crown or root caries and tooth loss in adult patients suffering from periodontitis in relation to their adherence to supportive periodontal care (SPC). Five electronic databases were searched for studies from 1947 to 2025. Odds ratios (or) were calculated for continuous outcome data (e.g., the number of new caries lesions or lost teeth) in a fixed or random-effects model. Thirty-nine articles, reporting 34 studies with 9685 patients at baseline with at least 157 779 teeth, were included. One study investigated the development of root caries at tooth level, 25 examined tooth loss at patient level, and 13 tooth loss at tooth level. A meta-analysis was not feasible for the outcome root caries. At patient level, significantly more less-adherent patients experienced tooth loss compared with adherent patients (OR = 1.50, 95% CI: 1.11-2.01). At tooth level, adherent patients showed significantly fewer lost teeth than less-adherent patients (OR = 1.64, 95% CI: 1.17-2.29). Adhering to SPC reduces the risk of tooth loss in periodontitis patients. In contrast, evidence on root caries prevention is limited, with only one study addressing this outcome. Prevention of caries and subsequent tooth loss is highly relevant for patients undergoing SPC. However, it remains insufficiently addressed in the current literature, underscoring the need for further well-designed studies investigating caries progression in periodontally compromised patients.
This systematic review intends to respond to the question: "How do clinical parameters change in implants affected by peri-implant mucositis following different non-surgical treatment approaches or no treatment in patients monitored for a minimum of six months?" A search for randomized clinical trials (RCTs) or prospective controlled clinical studies (NRCT) in MEDLINE-PubMed, Cochrane Central Register of Controlled Trials, and Web of Science was performed between May 2015 and April 2025. After a two-step screening, data extraction and risk of bias (RoB) assessment were performed. A network meta-analysis (NMA), incorporating multi-arm RCTs, was planned. Twenty-one studies (19 RCTs; 2 NRCTs; 1068 patients) were included. The treatments comprised curettes, (ultra)sonic scalers, air-polishing, laser, antimicrobials, probiotics, and antibiotics, alone or in combination. Patient-related systemic and local factors and operator-related factors were sporadically reported and analyzed. To various extents all treatments resulted in a reduction in BOP. When reported, peri-implant mucositis resolution was achieved in a subset of patients, ranging from 9% to 100% (only in one study group). Microbiological and immunological data and patient-reported outcomes (PROs) were sparsely and heterogeneously reported. Only one-third of the studies presented low RoB. Due to limited data available and heterogeneity in treatment protocols and outcomes among the included studies, a NMA could not be performed. Within the limitations of this review, different nonsurgical treatment protocols, including mechanical debridement alone, all improved clinical parameters, whereas adjuncts yielded only minor improvements after 6 months. Standardized outcome sets and routine PROs are needed to improve comparability and decision-making in future studies.
To evaluate the clinical and radiographic efficacy of the adjunctive use of hyaluronic acid (HA) in regenerative periodontal surgery for the treatment of intrabony defects. A systematic search identified randomized controlled trials (RCTs) involving adult patients with intrabony defects who underwent regenerative periodontal surgery with adjunctive HA. The primary outcome was probing pocket depth (PPD) reduction; secondary outcomes included clinical attachment level (CAL) gain, gingival recession (REC), and radiographic defect depth (RDD) reduction. Meta-analysis according to the regenerative protocol was performed using random-effects models, with subgroup analyses. Fourteen RCTs met the inclusion criteria. Compared to controls, adjunctive HA resulted in an additional PPD reduction of approximately 0.7-1.2 mm and CAL gain of 0.7-1.1 mm, with more consistent effects at 12 months. Subgroup analyses indicated significant benefits when HA was applied alone or with membranes, whereas no added benefit was observed with bone substitute materials. Radiographic outcomes showed a favorable trend for HA, with an additional RDD reduction of about 0.7-1.0 mm, though heterogeneity was noted. Comparisons between HA and enamel matrix derivative (EMD) revealed comparable or slightly superior results for EMD. Adjunctive HA may enhance clinical and radiographic outcomes in intrabony defects when used in regenerative periodontal surgery, although heterogeneity and study quality warrant cautious interpretation of the findings.
Multiple gingival recessions can lead to esthetic impairments and may require surgical root coverage. Esthetic outcome measures can be assessed from both professional and patient perspectives. Several objective and subjective outcome measures have been applied for these evaluations. To systematically review and conduct a meta-analysis of the available literature on professional esthetic assessments and patient-related outcome measures (PROMs) following surgical root coverage procedures for the treatment of multiple gingival recessions. A computerized systematic search was conducted in the MEDLINE (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials databases up to May 2024 to identify eligible studies meeting the inclusion criteria. A total of 32 randomized controlled trials involving 1012 patients and 3589 multiple gingival recessions were included. No case-series studies meeting the inclusion criteria were retrieved. Meta-analyses demonstrated that root coverage procedures statistically significantly improved both professionally assessed and patient-reported esthetic outcomes. The overall weighted mean Root Coverage Esthetic Score (RES) was 8.31 (95% CI: 8.11-8.50), with comparable results across coronally advanced flap (CAF) and tunnel (TUN) techniques, particularly when combined with autogenous connective tissue grafts or graft substitutes. Patient-reported esthetic satisfaction, measured primarily by visual analog scales (VAS), showed a pooled mean of 8.59 (95% CI: 8.29-8.89). Mean root coverage (MRC) reached 82.6% (95% CI: 71.3-93.9), and complete root coverage (CRC) was 62.7% (95% CI: 57.0-68.4). Statistically significant reductions in recession depth (mean difference = 2.22 mm) and gains in keratinized tissue (0.74 mm), gingival thickness (0.56 mm), and clinical attachment level (2.17 mm) were observed. Postoperative pain was low across techniques (VAS 0-10 mean: 2.67; VAS 0-100 mean: 24.34). Metaregression revealed a positive association between MRC and RES (R2 = 0.345) but no significant correlation between MRC and patient esthetic perception (R2 = 0.091), underscoring the divergence between clinical and patient-reported outcomes. The results of this systematic review and meta-analysis, focusing on multiple gingival recessions, suggest that (a) CAF and TUN with the adjunctive use of autogenous graft support esthetic improvement from both professional and patient perspectives and (b) CAF and TUN with the adjunctive use of autogenous graft or graft substitutes are effective in root coverage outcomes with a minimal postoperative morbidity.
Global population aging is leading to a greater retention of natural teeth into later life and an increasing prevalence of dental implant therapy. Although advanced age has traditionally been regarded as a risk factor for compromised outcomes, population level evidence remains lacking. This review synthesizes large-scale clinical and population-level studies to evaluate whether chronological age constitutes a genuine limiting factor for periodontal and implant treatment. This review compared tooth loss rates, periodontal soft and hard tissue status, and treatment outcomes between younger and older cohorts. Regarding implant therapy, the assessment primarily evaluated success and survival rates across various time periods, peri-implant bone loss, relevant clinical parameters, as well as implant allergies, peri-implantitis, and peri-implant mucositis. Furthermore, data on orthopedic implants were analyzed to provide a comparative perspective on age-related biomaterial integration. Periodontal treatments remain significantly effective, although outcomes of non-surgical periodontal therapy vary among different age groups. Surgical periodontal therapy outcomes show no significant age-related differences. Advanced age is not consistently associated with higher implant failure rates. Several studies report comparable or even higher survival rates in older patients. Marginal bone loss and probing depths are similar across age groups. Orthopedic implant literature similarly shows that age alone does not preclude successful outcomes. Aging is not a contraindication for periodontal or implant therapy and is not a default risk factor for failure. Thorough evaluation of systemic health and individualized treatment planning are more critical for overall treatment success than a patient's chronological age.
Non-surgical periodontal therapy (NSPT) remains the fundamental approach in periodontal treatment and has been extensively studied over the past decades. Evidence consistently shows that NSPT exerts a substantial and sustained impact on tooth retention and on key surrogate outcomes, including gains in clinical attachment levels, reductions in probing pocket depths and improvements in inflammatory parameters. To evaluate the long-term (≥5 years) efficacy of non-surgical periodontal therapy and to explore the effect of alternative or adjunctive mechanical methods (e.g., laser, air-polishing devices, etc.) compared to hand, sonic, or ultrasonic instruments in NSPT. A systematic electronic search was conducted to analyse the scientific literature available by including all potential studies reporting long-term results of the non-surgical periodontal treatment, regardless of study design. To evaluate the effectiveness of alternative protocols for subgingival instrumentation, a systematic electronic sear was also conducted including only randomized clinical trials (RCTs). 27 manuscripts corresponding to 20 investigations reported on the long-term outcomes of non-surgical therapy. Most of the studies showed low incidence of tooth loss, clinical attachment gains at initially deep pockets and probing pocket depth reductions, especially on those patients attending regularly supportive periodontal care (SPC). The use of laser as an alternative to hand instruments or ultrasonic devices, or as adjuncts to subgingival instrumentation has shown conflictive results. Some studies evaluating the adjunctive use of antimicrobial photodynamic therapy have reported modest clinical improvements in the short term (3 to 6 months). Subgingival air-polishing may offer potential benefits for patient comfort and shorter treatment times. Overall, the available evidence supports NSPT as a reliable and long-lasting treatment option, while emphasizing the need for further research on patient reported outcomes and systemic effects within the long-term framework of comprehensive periodontal treatment. Non-surgical periodontal therapy is the key tool for treating periodontitis in most patients. The gold standard treatment is subgingival instrumentation using hand- or power-driven instruments, together with regular SPC. Various alternative or adjunctive therapies have been suggested, but the evidence available is limited, particularly in the long term.
This scoping review aimed to identify the pain scales used to clinically evaluate dentin hypersensitivity (DH) in existing literature and the references provided for their selection. The scoping review followed the PRISMA and JBI guidelines. An electronic search of the literature was conducted across Web of Science, PubMed (Medline), Scopus, and CINAHL. Eligible studies included adult participants with DH who were assessed using pain scales. After screening, data were extracted and synthesised to identify the most commonly used pain scales and the theoretical and methodological justification for their use. Seventy-one studies were included in the review, and most of them were randomised studies (randomised clinical studies + RCTs = 81.7%). The visual analog scale (VAS) was the most frequently used pain measurement, followed by the Schiff Cold Air Sensitivity scale (SCASS). Use of both scales together was also identified as a common practice. There were inconsistencies in the references provided as the rationale for the use of the pain measurement tools. VAS and SCASS are unidimensional scales that are used in DH research without an adequate theoretical understanding of the condition and methodological considerations. More research needs to be conducted on the methodological suitability of the pain scales and the conceptual understanding of pain management in DH.
Supportive periodontal and peri-implant maintenance therapy is strongly associated with improved long-term retention and stability of natural teeth and dental implants. Lack of regular professional follow-up after initial therapy is a major risk factor for disease recurrence and tooth or implant loss. Despite well-established benefits, patient compliance with maintenance regimens remains suboptimal, and the ideal protocols and intervals for sustained tissue health are under debate, AIM: This review aimed to synthesize current evidence regarding the impact of supportive therapy on long-term periodontal and peri-implant tissue stability, including optimal maintenance intervals, protocols, risk profiles, and emerging technologies for personalized care. A comprehensive literature review was conducted using PubMed, Embase, and Scopus databases, focusing on longitudinal and cohort studies, randomized controlled trials, systematic reviews, and recent consensus guidelines addressing the effects of supportive therapy on periodontal and peri-implant outcomes. Data on maintenance intervals, clinical protocols, risk assessment tools, recurrence after nonsurgical and surgical therapies, and adjunctive innovations (AI, imaging, biomarker testing) were collated and critically appraised. Long-term studies consistently demonstrate that regular supportive periodontal care (SPC) and supportive peri-implant care (SPIC) markedly reduce rates of tooth and implant loss, progression of periodontitis and peri-implantitis, and minimize the need for complex surgical re-interventions. Frequent recalls-every 3-6 months for moderate- to high-risk patients and up to 12 months for low-risk-result in significantly better outcomes. Protocols incorporating individualized risk assessment (e.g., Personalized Risk Assessment (PRA) and Implant Disease Risk Assessment (IDRA) algorithms), thorough mechanical biofilm removal, personalized oral hygiene instructions, and modification of risk factors enhance tissue stability. Non-compliance and residual pockets (≥5-6 mm) are major predictors of recurrence. While both conventional and emerging biofilm control methods (ultrasonic scaling, air-polishing, guided biofilm therapy) are effective, no single protocol shows superior long-term results. Recent advances in chair-side biomarker testing and AI-supported image analysis offer promising tools for early detection and proactive management of at-risk patients. Although early data are encouraging, the clinical integration of these technologies remains largely guided by expert interpretation pending long-term outcome validation. Consistent adherence to structured supportive therapy protocols following active periodontal or implant interventions is essential for the long-term health and stability of periodontal and peri-implant tissues. Maintenance intervals and protocols should be individualized based on patient, site, and prosthetic risk profiles, with cumulative and interceptive strategies employed for disease prevention and early management of recurrence CLINICAL RELEVANCE: The implementation of personalized supportive therapy regimens-including regular recalls, risk-based protocol selection, and integration of emerging technologies-substantially enhances the longevity and stability of teeth and implants. Improving patient and clinician awareness, and adopting risk-stratified approaches, can reduce disease recurrence, treatment burden, and long-term healthcare costs.
This narrative synthesizes current knowledge on the biological mechanisms, clinical challenges, and regenerative innovations for optimizing intraoral wound healing in the elderly. Narrative review of preclinical and clinical studies addressing age-related changes in the four canonical wound-healing phases (hemostasis, inflammation, proliferation, remodeling), tissue-specific molecular pathways, systemic and local factors affecting repair, operative considerations, and emerging therapeutic modalities. Data sources included PubMed, Embase, and Cochrane databases through June 2025. Aging compromises each repair phase. Hemostasis is prolonged by diminished platelet function and altered clot architecture. Inflammation is exacerbated by impaired neutrophil/phagocyte activity and persistent reactive oxygen species. Proliferation is slowed by reduced fibroblast proliferation and angiogenic signaling, while dysregulated matrix metalloproteinase activity impairs extracellular matrix remodeling. Tissue-specific cues in oral mucosa, periodontal ligament, cementum, and bone are also altered with age. Compounding factors-including "inflamm-aging," malnutrition, polypharmacy-induced xerostomia, cognitive decline, and frailty-further impede healing. Clinical optimization requires comprehensive preoperative risk and frailty assessments; medical/nutritional management; minimally invasive flap designs; tension-free primary closure; streamlined surgical protocols to limit operative time; and postoperative monitoring with tailored communication. Emerging regenerative strategies-growth factors (PDGF, FGF), platelet concentrates, gene and cell-based approaches (MSCs, exosomes), immunomodulatory scaffolds/agents, photobiomodulation, and AI-driven risk dashboards-show promise for enhancing repair in aging populations. Effective oral wound healing in older adults demands a multidisciplinary, personalized approach that integrates meticulous perioperative care with novel regenerative modalities. Standardization and clinical validation of emerging therapies are essential to translate biological insights into improved patient outcomes.
Periodontitis complicates orthodontic treatment due to compromised periodontal support and heightened susceptibility to inflammation. Effective plaque control is essential before, during, and after orthodontic intervention to maintain periodontal stability and prevent disease recurrence. This narrative review explores evidence surrounding the importance of oral hygiene instruction (OHI), patient motivation, and behavior change strategies in managing ortho-perio patients. Evidence suggests that behavior change is complex and knowledge alone is insufficient to maintain long-term self-care without clinician support and patient engagement. Individually tailored OHI, combined with patient-centered communication, can foster sustainable self-care habits. Ortho-perio oral hygiene routines are unique considering periodontal status and evolve alongside changes in orthodontic appliances. Emphasis should consistently be on four critical areas: the gingival margins, interproximal spaces, orthodontic brackets and archwires, and fixed retainers. Orthodontic treatment in patients with periodontitis is a dynamic process with constant oral environment changes. Ongoing personalized education and behavior change strategies tailored to treatment stage and periodontal risk are essential to support patient self-care and ensure long-term oral health. A multidisciplinary approach from periodontal and orthodontic clinicians, involving ongoing education, customized hygiene strategies, and behavior support, is critical to achieving optimal treatment outcomes in ortho-perio patients.
Skin aging is a multifactorial process mediated by intrinsic (genetic and metabolic) and extrinsic (environmental) factors leading to functional and structural deterioration, including wrinkles, loss of collagen and elastin, as well as various pigmentation disorders. Exosomes, the smallest subset of extracellular vesicles, have emerged as potent cell-free regulators of intercellular communication with significant regenerative potential. This scoping review synthesized available in vitro, in vivo, and clinical evidence investigating the role of exosomes in facial esthetics and skin rejuvenation. A comprehensive literature search was conducted up to January 2nd, 2026, using PubMed, Scopus, Web of Science, and Google Scholar. Search terms included ((extracellular vesicle) OR (exosome)) AND ((esthetic) OR (aesthetic) OR (rejuvenation)). All in vitro, in vivo, and human clinical studies were included without restriction. A total of 54 studies (from 472 records) were included: 27 in vitro, 16 in vivo, and 29 clinical studies (several overlap). In vitro outcomes demonstrated that exosomes improved cell viability, proliferation, and migration, while enhancing extracellular matrix formation (collagen, elastin, fibronectin) and upregulating antiaging-associated gene expression. These impacts were accompanied by alleviated inflammation, oxidative stress, and regulation of senescence and autophagic signaling. Animal research supported these outcomes, showing enhanced fat graft retention, improved angiogenesis, facilitated dermal remodeling, and epidermal thickening, together with expedited wound repair and reduced expression of matrix metalloproteinases and inflammatory regulators. Clinical studies consistently report decreases in wrinkles, pore size, erythema, scarring, and hyperpigmentation, along with improved skin elasticity, texture, hydration, and thickness. Both patient-reported and clinician-assessed outcomes, including the Global Aesthetic Improvement Scale, demonstrate positive outcomes. Additional advantages included decreased acne severity, shorter recovery times, and fewer adverse effects. Exosomes showed substantial regenerative potential in facial esthetics and skin antiaging. Nevertheless, heterogeneity in study methodologies and the limited number of high-quality RCTs require further well-designed studies to establish optimized protocols and ensure long-term efficacy and safety.
Coronally advanced flap (CAF), either alone or in combination with a connective tissue graft (CTG), represents one of the most extensively investigated surgical approaches for the treatment of gingival recessions, demonstrating high rates of mean root coverage (MRC) and complete root coverage (CRC). However, evidence regarding their long-term performance remains limited. This review critically analyzes the long-term clinical performance of CAF alone and in combination with CTG, examining root coverage outcomes, stability of the gingival margin, keratinized tissue (KT), and gingival thickness (GT) gain, and esthetic integration over extended follow-up periods. The influence of baseline phenotype, surgical modifications, and specific clinical scenarios on long-term success is explored. A comprehensive narrative review of randomized clinical trials (RCTs), controlled studies, case series, and retrospective cohorts with a minimum follow-up of 5 years was conducted. Outcomes were stratified by surgical technique (CAF vs. CAF + CTG), defect complexity, and follow-up duration (5 to >20 years). CAF alone demonstrates satisfactory short-term coverage but exhibits gradual apical relapse over time, particularly in inadequate phenotype. Long-term studies indicate progressive reduction of CRC, with stability strongly linked to early gingival margin position and phenotype maturity. In contrast, CTG adjunctive therapy consistently enhances long-term stability by increasing KT and GT, improving resistance to mechanical and biological relapse. According to the authors' experience, CTG is especially beneficial in anatomically or etiologically complex conditions. Extended follow-up (>20 years) confirms the enduring role of CTG-driven phenotype modification in preventing marginal relapse. Long-term success in root coverage procedures is predominantly phenotype-dependent. While CAF alone may be appropriate in selected sites with favorable anatomical and phenotypic features, CAF + CTG remains the gold standard for securing stable outcomes over time, particularly in challenging clinical scenarios. The drawbacks of applying CTG must be considered alongside the treatment benefits. Future therapeutic algorithms should incorporate a phenotype- and defect-driven approach to optimize the lifetime stability of periodontal plastic surgery outcomes.
Peri-implantitis is a biofilm-induced inflammatory condition with challenging management due to the complexity of implant surface topographies and the polymicrobial and well-structured profile of the biofilm colonizing these surfaces. Adjunctive use of antibiotics has been explored to enhance the outcomes of both surgical and non-surgical therapies, but its impact remains questionable. To critically evaluate the clinical effects of systemic and local antibiotic therapies, combined with mechanical debridement (MD), in the surgical and non-surgical treatments for peri-implantitis. Five databases and gray literature were systematically searched through March 2026. Twenty-one studies involving 1,718 implants were included. Pairwise and network meta-analyses were conducted using random-effects models to compare the efficacy of antibiotic regimens on clinical parameters, including probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BoP), plaque index (PLI), and marginal bone loss (MBL). Systemic metronidazole combined with amoxicillin was most effective in reducing PPD and MBL, especially when used in the surgical treatment of peri-implantitis. For non-surgical intervention, metronidazole demonstrated the most effective results, particularly for CAL and MBL. Minocycline microspheres and the combination of amoxicillin and metronidazole showed the best results among local therapies. Overall, antibiotics improved clinical parameters when compared to mechanical debridement alone, but with substantial microbiological variability depending on the delivery method and intervention type. The most effective treatments were metronidazole as adjunct to non-surgical treatment and combined with amoxicillin adjuncts to open flap debridement. While local antibiotic applications also enhance clinical parameters, they appear less effective than systemic regimens. Future well-designed clinical trials focusing on microbiological outcomes and standardized protocols are warranted to optimize periimplantitis management strategies.
This article critically reviews the current knowledge on the factors influencing the efficacy of non-surgical therapy (NST) of peri-implantitis, taking also advantage of the know-how from periodontitis management. Despite the limited available literature, it is clear that factors influencing the possibility to access and effectively decontaminate the implant (by the clinician and by the patient) and factors influencing patients' response and their wound healing potential are likely to play a crucial role. In this respect, assessing the appropriateness of implant-supported prostheses and verify their cleanability (and, whenever needed, modify/replace them) becomes of crucial importance. Likewise, promoting smoking cessation, controlling underlying relevant medical conditions (e.g. type 2 diabetes) and improving patient's compliance to meticulous oral hygiene can enhance NST outcomes. Future studies are needed to better clarify the plethora of factors impacting on NST efficacy and how clinicians can further promote disease resolution by selecting/adapting decontamination protocols, use of adjunctives and motivation strategies. Although NST is always the first treatment approach in peri-implantitis management, its efficacy in promoting disease resolution is currently limited, especially in cases presenting advanced pathology and complex peri-implant defect configurations. It is becoming increasingly clear that successful NST does not only entail an effective biofilm removal, but it requires a multi-level approach where the peri-implant tissues are considered in close interrelation with the implant-abutment-prosthesis complex.
As the understanding of periodontal disease has evolved, therapeutic strategies have increasingly shifted from pathogen eradication toward ecological modulation of the oral microbiome. Within this paradigm, probiotics have emerged as potential adjuncts for maintaining periodontal health by promoting microbial balance and modulating host responses. To summarize the historical development, definitions, and mechanisms of probiotics and to critically evaluate the current clinical evidence supporting their use in periodontal therapy. This narrative review examines the conceptual framework of probiotics in oral health, distinguishing them from related approaches including prebiotics, postbiotics, and synbiotics. Literature from randomized controlled trials and meta-analyses was reviewed to assess the clinical effectiveness of probiotic interventions in periodontal therapy and to explore their proposed mechanisms of action. Probiotic effects are highly strain-specific and involve multiple mechanisms, including production of antimicrobial compounds, competition for ecological niches, inhibition of biofilm formation and quorum sensing, strengthening of epithelial barrier integrity, and modulation of host immune and inflammatory responses. Evidence from randomized controlled trials and meta-analyses, particularly those evaluating Limosilactobacillus reuteri strains, suggests that probiotics used as adjuncts to nonsurgical periodontal therapy can significantly improve clinical parameters such as probing pocket depth, clinical attachment level, and bleeding on probing. However, substantial heterogeneity in study design, probiotic strains, delivery systems, and follow-up periods limits the comparability and generalizability of findings. Probiotics represent a biologically plausible and ecologically oriented adjunct in periodontal therapy. While current evidence indicates beneficial clinical effects, further standardized and long-term clinical trials incorporating advanced microbiome analyses (e.g., next-generation sequencing) are needed to clarify mechanisms, optimize formulations, and support personalized probiotic strategies in periodontal care.
Population aging is reshaping prosthodontic care for both partially and completely edentulous individuals. In older adults, conditions such as frailty, comorbidities, polypharmacy, and cognitive decline can have a direct impact on the biological and biomechanical demands of implant therapy, thereby influencing the success of implant treatment. This narrative review synthesizes evidence on implant therapy in older patients, integrating prosthetic and biomechanical considerations with patient-related factors. The literature search addressed implant survival, complications, prosthetic and material design, peri-implant soft tissue considerations, and treatment options such as shortened dental arch approaches, implant-assisted removable partial dentures (IARPDs), implant overdentures, and complete dentures, as well as maintenance strategies with patient and caregiver education. Implant survival in older patients remains high, and age alone should not be considered as a limiting factor for implant treatment. Hygiene-oriented prosthetic designs, including non-mucosa-contact intaglio surfaces and emergence angles less than 30°, were associated with reduced plaque accumulation and peri-implant bone loss in older adults. While limited keratinized mucosa correlated with greater plaque and recession, phenotype modification should be evaluated on a case-by-case basis, carefully weighing the benefits against the surgical burden for the older patient. Ceramic materials accumulate less plaque as compared with processed acrylic resin, and veneered zirconia remained more prone to chipping than monolithic zirconia. Alternative treatment options-such as overdentures to enhance bite force, a shortened dental arch when posterior implants are contraindicated, or IARPDs to improve stability-may be especially appropriate for older patients with functional limitations. Caregiver participation and structured maintenance significantly reduce peri-implantitis risk. Implant therapy in older patients, including individuals aged 75 years and above, is highly feasible when age-related risks are addressed, prostheses are designed for cleansability and retrievability, and maintenance includes structured follow-up and caregiver support. Clinicians should emphasize functional goals, hygiene-accessible designs, pragmatic treatment alternatives, selective peri-implant soft tissue management when indicated, and personalized maintenance supported by patient and caregiver education.
Aging is accompanied by a chronic low-grade inflammatory process, known as inflammaging, as well as immunosenescence, an age-related decline and dysregulation of immune function, and cellular senescence, a process in which cells enter a state of irreversible growth arrest while actively releasing pro-inflammatory factors. These processes alter the host immune regulation and tissue homeostasis. Aging-associated mechanisms are being explored for their role in periodontal and peri-implant diseases because of their promotion of dysregulated inflammation, impaired healing, and heightened susceptibility to tissue destruction. Rather than viewing periodontitis as a condition driven solely by microbial burden, it should be understood as a multifactorial disease shaped by complex host-microbe interactions, in which host-driven processes, particularly senescence and inflammaging, play a central role in amplifying bidirectional oral-systemic interactions. This scoping review aims to (i) highlight the current understanding of the role of aging and its alterations in host inflammatory responses on immune function, tissue homeostasis, and cellular stress responses; (ii) explore the potential impact of "inflammaging" on the periodontium and interactions with systemic health; and (iii) explore possible therapeutic targets for senotherapy. A literature search of the PubMed database was conducted using Boolean search strategies to identify publications related to the potential connections between aging and inflammation in the context of the oral cavity. Of the total 283 articles that were screened, 87 met the eligibility criteria and were included in this scoping review. An additional 51 articles were obtained via manual search. The evidence demonstrates a link between inflammaging, age-related cellular senescence, and periodontal vulnerability to periodontal pathogens and periodontal destruction. Both experimental and clinical studies have shown increased senescence markers, dysregulated immune responses, and enhanced osteoclastic activity that lead to greater tissue destruction and alveolar bone loss. Systemic conditions such as Alzheimer's disease, diabetes, and cardiovascular disease can also amplify the inflammatory burden through shared pathways. Overall, our findings support the idea that older adults undergo immune dysregulation when challenged with microbes that ultimately cause a chronic periodontal inflammatory state.
Smoking tobacco is a critical modifiable risk factor for periodontal and peri-implant diseases. This narrative review integrates established behavioral theories with communication-based psychological processes to propose an evidence-based model for smoking cessation support in periodontal care. While the model is developed around smoking cessation, its underlying principles are applicable to broader behavioral risk factor management in dental practice. Evidence from systematic reviews, randomized controlled trials, and international guidelines was synthesized to determine effective strategies. Key concepts analyzed include the transtheoretical model (TTM), the COM-B model and motivational interviewing (MI), and the impact of personalized risk communication and biofeedback on patient adherence. Structured behavioral interventions, particularly in combination with pharmacotherapy and personalized feedback (e.g., risk scores or biomarker testing), improve quit rates and, consequently, periodontal outcomes. The proposed four-stage behavioral support staircase provides a clinical support structure comprising connection (rapport), information, motivation and action, with continuous evaluation. Complementing this is an "elemental" metaphor to guide clinicians through patient resistance, ambivalence, and the emotional adaptation inherent in cessation. Smoking cessation serves as a model for how structured behavioral support can be integrated into periodontal therapy. The presented frameworks provide oral health professionals with guidance on the complex cognitive, emotional, and motivational transitions necessary for achieving long-term periodontal stability. This educational model enables periodontal teams to systematically address modifiable behavioral risk factors. It offers a four-stage approach to supporting cessation and managing relapse, shifting the focus from didactic instruction to a patient-centered collaborative approach.
High interest has been recently shown toward the use of hyaluronic acid (HA) gel as adjuvant to nonsurgical but also to surgical periodontal therapy. To update the knowledge on the potential clinical effects of HA when used in conjunction with nonsurgical and surgical (both regenerative and mucogingival) periodontal therapy by applying the latest Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Three different PICOS frameworks were used to guide the inclusion of eligible studies dealing with the adjunctive application of HA in nonsurgical, surgical periodontal therapy, and in root coverage procedures. The following variables were considered: clinical attachment level gain (CALgain), pocket depth reduction (PPDred), recession reduction, pocket closure (for nonsurgical), bleeding score (for nonsurgical), bone gain (for surgical and nonsurgical), percentage of root coverage (%RC, for root coverage procedures). A detailed systematic search was conducted in the following targeted electronic databases: Medline via Pubmed, EMBASE, Cochrane Database of Systematic Reviews and Scielo. Studies were grouped into three predefined analytical strata corresponding to nonsurgical therapy, surgical periodontal therapy, and mucogingival procedures, allowing separate meta-analyses tailored to each clinical scenario. Risk of Bias assessment was performed by using the RoB 2.0 Tool and the overall strength of the available evidence was determined by using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. From 1554 records, 31 studies were included in the systematic review, but only 20 were eligible for meta-analysis. In nonsurgical periodontal therapy, the adjunctive application of HA showed an overall statistically significant improvement in terms of CALgain (difference of 0.72 mm, 15 studies), PPDred (difference of 0.57 mm, 16 studies), and bone gain (difference of 0.56 mm, 2 studies). However, when only studies at low risk of bias were considered, the statistically significant difference was not confirmed. No statistically significant differences were observed for recession reduction, pocket closure and bleeding score. In surgical periodontal therapy, two studies suggested greater CALgain (difference of 1.36 mm, 2 studies) and PPDred (difference of 1.03 mm, 2 studies) with adjunctive HA, though both trials were at unclear risk of bias. For mucogingival procedures, two studies showed a modest increase in %RC RC (difference of 15.29%, 2 studies), while no benefit was found for other clinical parameters. Within its limitations, the present analysis shows that the adjunctive use of HA produces variable clinical effects across periodontal therapies. Small improvements are observed in nonsurgical treatment, and limited data suggest a potentially favorable effect in periodontal healing. Overall, the current evidence does not allow definitive clinical recommendations, and further well-designed trials are needed to clarify the therapeutic role of HA.