British Society of Periodontology

Background: This retrospective study assessed long-term survival outcomes of severely periodontally compromised mandibular incisors (≥50% bone loss) following initial periodontal treatment and a structured recall protocol. Methods: Ninety-three patients with ≥50% bone loss in all mandibular incisors were treated in a private practice over a 32-year period by the same periodontist. Following initial treatment, patients were assigned 6- or 12-month recall intervals based on response and motivation. The baseline was set after subgingival debridement (visit 3). Last follow-up visit (LFV) in this study was defined as follows: the last control visit of the patients done by the periodontist. 'Survival' was divided into 3 groups: complete survival (CS), all incisors were still present, and partial survival (PS), one or two incisor(s) were lost. Total failure (TF) involved instances in which all incisors were lost. Effective survival was monitored when an extracted tooth was repositioned and stabilized with a splint, ensuring preservation of function. Only 9.7% of patients needed a mandibular incisal splint. For reasons of consistency the CPITN was used. Statistical analysis was performed in R. The significance level was set at α = 0.05. Event-free patients can be considered as uninformative censoring, all with the same probability of risk, as they all were still in follow-up at the time of informed consent approval. Results: A total of 93 patients were included in the study. The mean follow-up was 17.7 years. At the last visit, 79.6% of patients retained all incisors, with an effective survival rate of 89.2%. Regarding the survival probability over time, after 15 years, it is 91% (95% CI: 0.86-0.98), and after 20 years, it is 78% (95% CI: 0.69-0.90). The effective survival probability over time after 15 years was 95% (95% CI: 0.91-1.0), and after 20 years, it was 89% (95% CI: 0.81-0.98). Compliance significantly influenced survival (p = 0.007), whereas the number of occluding units did not (p = 0.226). The total amount of teeth lost during the entire follow-up period showed a statistically significant difference compared to survival (p < 0.001). The general periodontal health of the patient population presented a shift from CPITN 3 to the 0-2 group. Conclusions: Severely compromised mandibular incisors demonstrate high long-term survival rates with appropriate therapy. After 20 years the survival probability was 78%, and the effective survival probability, 89%, underscoring the critical role of lifelong periodontal care. Mandibular incisor preservation over long-term follow-up is highly achievable.

BackgroundDiagnosing oral lesions from benign conditions to oral cancer remains challenging due to overlapping visual features and reliance on histopathology. Large language models (LLMs) can integrate textual and visual cues, but their diagnostic accuracy and clinical utility in real decision-making contexts remain uncertain. To systematically evaluate the diagnostic performance, clinical usefulness, and limitations of LLMs in identifying oral lesions.MethodsPubMed, CINAHL, Embase, Web of Science, and Google Scholar were searched to 20 July 2025. Eligible studies applied LLMs (e.g., ChatGPT, Gemini, DeepSeek, Copilot, Claude) for diagnosis or differential diagnosis of oral lesions using text, images, or multimodal inputs. Outcomes included diagnostic accuracy, agreement metrics, and qualitative assessments of explanation quality and clinical applicability. Risk of bias was assessed using an adapted QUADAS-2. Narrative synthesis was performed due to heterogeneity.ResultsSeventeen studies (>1,200 cases) were included. Diagnostic accuracy ranged from 25%–96%, varying by model version, input modality, and lesion complexity. Multimodal inputs consistently improved performance, with Cohen's κ up to 0.85–0.90. Advanced models (GPT-4o, DeepSeek-R1, o1-preview) outperformed earlier versions and approached expert performance in some tasks, although specialists generally retained superior Top-1 accuracy. Clinical utility was highest when LLMs were used to structure differential reasoning, highlight red-flag features, and support communication, but limited in tasks requiring fine morphological interpretation or severity grading. Overall risk of bias was low to moderate.ConclusionsLLMs demonstrate variable diagnostic performance and context-dependent supportive utility as adjunctive tools in oral lesion assessment, particularly in multimodal settings. They should complement, rather than replace, expert clinical judgment. Future research should prioritize real-world workflow evaluation, standardized prompting strategies, and prospective clinical validation.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251090315, identifier CRD420251090315.

Background The lack of peri-implant keratinized mucosa (<2 mm) is associated with plaque accumulation and pain during brushing, and consequently peri-implant disease. This case series aimed to evaluate the effectiveness of a free gingival graft in combination with an apically positioned flap to modify the peri-implant phenotype. The primary outcome was the change in keratinized mucosa width (KMW), and the secondary outcomes were pocket probing depth, plaque index, gingival index, pain upon brushing, and aesthetic appearance of the graft. Methodology A total of nine patients were treated with 16 implants placed in areas with a lack of KMW (<2 mm). After osseointegration and before the delivery of the final prosthesis, a free gingival graft in combination with an apically positioned flap was performed. All patients were followed up at 3, 6, and 12 months after surgery. Results The mean gain in KMW at 12 months was 2.51 mm. The change in KMW was statistically significant (p = 0.001). Plaque index and gingival index were reduced. Patients were satisfied with the aesthetic appearance and experienced less pain upon brushing. Conclusions Within the limitations of this case series, the use of a free gingival graft in combination with an apically positioned flap can modify the peri-implant phenotype by increasing the KMW and improving peri-implant health parameters.

Epidemiological studies suggest a link between gestational diabetes mellitus (GDM) and periodontitis. In this context, Porphyromonas gingivalis (Pg) and its byproducts, including lipopolysaccharide (Pg-LPS), may translocate to the placenta, potentially intensifying pro-inflammatory mechanisms in a hyperglycemic environment. This study aimed to assess the pro-inflammatory simultaneousstimulus effectof hyperglycemia (HG)andPg-LPSinhuman term placental explants. Fresh placental explants from healthy (n=10) and GDM (n=5) pregnant women were stimulated under normoglycemia (NG), hyperglycemia (HG), Pg-LPS, and a dual stimulus of HG+Pg-LPS. Both placental explants and culture supernatants were assessed using histology, real-time quantitative polymerase chain reaction (RT-qPCR), Western blot, immunofluorescence, and multiplex immunoassay to analyze histopathological alterations, Toll-like receptor (TLR)-2, -4, -9 mRNA expression, nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) phosphorylation and nuclear immunolocalization, NLRP3 inflammasome expression, and pro-inflammatory cytokines (interleukin [IL]-6, IL-1β, and tumor necrosis factor [TNF]-α). The dual stimulus (HG+Pg-LPS) increased fibrinoid necrosis (p<0.05) and upregulated TLR-4 mRNA (p<0.05) expression in placental explants, compared to other experimental conditions. NF-κB phosphorylation and nuclear immunolocalization, NLRP3 inflammasome and IL-6, IL-1β, and TNF-α mRNA expression increased upon the dual stimulus in healthy and GDM explants (p<0.05). Additionally, levels of IL-6 (p<0.01), IL-1β (p<0.01), and TNF-α (p<0.0001) increased in the supernatant from healthy and GDM explants under the dual stimulus. No differences in cytokine levels were observed between healthy and GDM placental explants under the dual stimulus. A hyperglycemic environment amplifies the pro-inflammatory response toPg-LPS in human placental explants, suggesting that hyperglycemia synergizes with Pg-LPS in the placenta. Bacteria that drive periodontitis, or their products, can enter the bloodstream and reach the placenta. In a high-glucose environment, this exposure can intensify placental inflammation. This study aimed to determine whether exposure to a high-glucose milieu, combined with byproducts of periodontal bacteria, activates inflammatory pathways in the placenta. Our results demonstrate that a high-glucose environment amplifies the inflammatory response to periodontal bacteria in human placentas from both healthy pregnancies and those complicated by gestational diabetes mellitus. These findings advance our understanding of the connection between periodontitis and gestational diabetes mellitus and underscore the role of oral bacterial translocation in placental tissues during pregnancy.

Background and Objective: The aim of this study was to evaluate the effects of enamel matrix protein, platelet-rich fibrin (PRF), and bone graft on new bone formation beyond the skeletal system by creating calvarial bone defects in rats. The effects were assessed using histopathological and immunohistochemical analyses. Materials and Methods: In this study, calvarial bone defects were created in male Sprague Dawley rats weighing 500–550 g. The animals were randomly divided into seven groups: Control (n = 13), Emdogain (EMD, n = 13), Emdogain + Bone Graft (EMD + BG, n = 13), Platelet-Rich Fibrin (PRF, n = 13), PRF + Bone Graft (PRF + BG, n = 13), Bone Graft (BG, n = 13), and PRF + Emdogain + Bone Graft (PRF + EMD + BG, n = 13). An additional group of 36 rats was used for PRF preparation. Titanium domes were placed on the calvarial bone defects, and the animals were sacrificed after three months. Bone samples were evaluated histopathologically for new bone formation, numbers of osteoblasts and osteoclasts, angiogenesis, and fibrosis. Immunohistochemical analysis of bone formation was performed using OPG and RANKL staining kits. Data were analyzed statistically. Results: The PRF group showed a significantly higher level of moderate new bone formation compared with the PRF + BG, EMD + BG, and PRF + EMD + BG groups (p ≤ 0.05). No significant differences were observed among the groups in terms of fibrosis or angiogenesis (p > 0.05). Similarly, OPG and RANKL levels, as well as the OPG/RANKL ratio, did not differ significantly between groups (p > 0.05). Conclusions: Based on the findings of this study, the combined use of Emdogain, PRF, and bone graft appears to have beneficial effects on enhancing bone formation in calvarial defects.

This critical narrative review presents the concepts and methods that have been or are currently applied in the treatment of periapical tissue changes in mature and immature permanent teeth. Treatment success is defined as the healing of the inflammatory lesion in permanent teeth and, additionally, the completion of root development in immature teeth. Background/Objectives: Endodontics focuses on the prevention and treatment of diseases affecting the dental pulp and periapical tissues. Periapical changes have been managed using various methods depending on factors such as the extent of the lesion and the stage of root and apical development. Conventional root canal treatment, revitalization, and apexification have all been employed. Methods: Three databases (PubMed, Scopus, and Web of Science) were searched for studies discussing different treatment approaches, materials, and the efficacy of techniques used over time in mature and immature permanent teeth. Results: This review includes seven case reports, seven case series, and three cohort studies, each detailing the treatment method, case characteristics, follow-up period, and treatment outcomes. Conclusions: Modern materials have significantly improved the outcomes of revitalization and apexification procedures. These methods can now compete with or even surpass the clinical effectiveness of conventional root canal therapy.

Introduction: Among the several tissue effects of laser irradiation arebiostimulation and photo disruption. What happens in the tissues is dependent onhow long the irradiation lasts and how much energy is given. Aim: This study setout to use histomorphometric analysis to determine how diode laser exposure affectedthe alveolar bone, periodontal ligament, and root surface in rats during experimentaltooth movement. Material and methods: Twenty albino rats were induced to haveorthodontic tooth movement group I (positive-control group) 10 rats got orthodontictooth movement alone and group II (study group) 10 rats got orthodontic tooth movementand subjected to Irradiation with Diode Laser (980 nm) applied perpendicular and incontact with the gums between two upper incisors with a power output of 300 mw. Theapplication was applied in a continuous mode. Histomorphometric analysis was doneat day 14. Results: Compared to orthodontic tooth movement alone, orthodontic toothmovement assisted by diode laser shows better results. All sites treated with orthodontictooth movement and diode laser showed a statistically significant improvement in allclinical markers. Conclusions: In orthodontic therapy, a low-level laser speeds up toothmovement by increasing metabolic activity in the alveolar bone around the teeth beingcorrected.

Introdução: O Transtorno do Espectro Autista (TEA) é frequentemente associado a crianças e jovens. Percebe-se que a população idosa autista ainda é negligenciada quando se fala em diagnóstico tardio, tratamento, reabilitação psicossocial, apoio familiar e social. Faz-se necessário entender as particularidades inerentes a essa condição e investigar de que maneira essa população tem enfrentado com o processo do envelhecimento. Objetivo: identificar os desafios enfrentados pela população idosa com TEA no processo de envelhecer. Metodologia: Estudo de revisão bibliográfica, do tipo narrativa, realizado no período entre 2019 e 2024. As bases de dados empregadas foram PUBMED e MEDLINE e ss buscas incluíram as palavras ‘’transtorno do espectro autista’’, ‘’autismo’’ e ‘’envelhecimento’’, além de termos em inglês ‘’autism spectrum disorder’’, ‘’autism’’ and ‘’aging’’. Encontrados 114 artigos na PUBMED e 55 na MEDLINE, incluídos 10 para o presente estudo. Resultados: Os idosos autistas enfrentam desafios específicos relacionados ao processo de envelhecer, como o declínio cognitivo e mudanças na saúde física. Os sintomas do TEA podem ser diferentes, dificultando o diagnóstico precoce que permite a possibilidade de terapias medicamentosas para diminuir os sintomas. Ressalta-se que o diagnóstico tardio implicará na diminuição da autonomia e da convivência com os demais. Conclusões: É essencial que haja maior conscientização sobre o autismo na população idosa e criadas estratégias de apoio a fim de compreender suas necessidades em adultos mais velhos. Torna-se importante reconhecer essas diferenças e oferecer suporte adequado para ajudá-los a lidar com essas dificuldades e assim melhorar sua qualidade de vida.

The periosteum consists of an outer fibrous layer and an inner cellular layer, where bone cells reside. Hence, it has been suggested that applying periosteum to a periodontal defect may help new bone formation. The purpose of this case study is to present the clinical and radiographic outcomes of a vestibular regenerative approach and the application of a connective tissue graft (CTG) with periosteum to improve the periodontal prognosis of a pathologically migrated hopeless tooth with an endo-periodontal lesion (EPL). A 35-year-old female presented with a hopeless tooth with EPL on #9. To preserve the papilla, a horizontal incision with two vertical releasing incisions was made on the buccal vestibule where the buccal bone was present. A CTG with periosteum was harvested from the tuberosity area. After applying enamel matrix derivative (EMD) and freeze-dried bone allograft (FDBA), the CTG was placed over the defect and stabilized with absorbable sutures. The flap was replaced and sutured, achieving primary closure and healing by primary intention. Following regenerative procedure, a localized orthodontic treatment was applied. A minimal ridge resorption, shallow probing depth, and radiographic stability of periodontal bone level were observed. This case study shows the successful application of a multidisciplinary approach to save a hopeless tooth with severe bone destruction and a non-contained periodontal defect. Multi-disciplinary approach including endodontic, orthodontic, and periodontal regenerative procedure can improve the prognosis of natural teeth. It would be beneficial to maintain the blood supply to the crestal part of the flap with apical incision. Connective tissue graft with periosteum could enhance the healing potential when used in adjunct with periodontal regeneration. The apical horizontal incision combined with periosteum graft could successfully save a tooth with severe bone destruction and a non-contained periodontal defect. The importance of wound stability on the papillae area was achieved with the vestibular approach with application of the room concept. This method would be beneficial to improve the periodontal prognosis of a severely periodontally compromised tooth.

English summary Biofilm control in the management of periodontitis Nor Tannlegeforen Tid. 2025; 135: 24-8. Periodontitis is one of the most common non-communicable diseases in adults. Despite being considered as a multifactorial inflammatory disease, the primary cause of periodontitis is a dysbiotic bacterial biofilm resulting in an adverse host response. Therefore, biofilm control represents the primary target of prevention (including primordial, primary and secondary prevention) as well as treatment. This text discusses approaches to clinical management, summarizing the guideline presented by the European Federation of Periodontology. We also present the latest understanding how biofilm control affects bacterial dysbiosis and evaluate the potential role of systemic antibiotics and «endpoint» testing of bacterial biofilm.