Proteome-Wide Mendelian Randomisation Identifies Causal Links of Plasma Proteins With Periodontitis.

OBJECTIVE: Periodontitis is a complex and multifactorial disease and it is challenging to decipher its underlying causes and mechanisms. This study attempted to explore potential circulating proteins in connection to periodontitis through proteome-wide Mendelian randomisation (MR). METHODS: We analysed 1722 circulating proteins to identify prospective drug targets for tackling periodontitis, using the genomic dataset from the FinnGen study. Two-sample MR was conducted to evaluate the bidirectional relationship between circulating proteins and periodontitis risk. A dataset from the UK Biobank was used to validate the findings. Single-cell analysis was performed to assess the cellular expression of the identified proteins within gingival tissues. RESULTS: MR analyses found that genetically predicted circulating levels of von Willebrand factor A domain-containing 1 (von Willebrand factor A domain containing 1 [VWA1], odds ratios: 0.94, 95% CI 0.92-0.97, P = 1.28 × 10-5) were inversely associated with periodontitis. In contrast, the level of growth differentiation factor 15 (growth differentiation factor 15 [GDF15], odds ratios: 1.05, 95% CI 1.02-1.07, P = 2.12 × 10-5) might be associated with an increased risk of periodontitis. Single-cell analysis indicated that VWA1 was primarily expressed in endothelial cells of healthy gingival tissues, while the main source of GDF15 was not derived from periodontal cells. CONCLUSIONS: The present study suggests that certain plasma proteins like VWA1 and GDF15 may be potentially indicative of the risk and susceptibility to periodontitis. These proteins could possibly be the potential therapeutic targets for treating periodontitis, and further investigation is highly warranted.

Learn, unlearn, and relearn post-extraction alveolar socket healing: Evolving knowledge and practices.

OBJECTIVE: This review was to offer a comprehensive analysis of currently available evidence on post-extraction alveolar socket healing, including i) the histological and molecular events during alveolar socket healing, ii) the dimensional ridge alterations after socket healing and controversies relating to sinus pneumatisation, iii) the patient-specific factors, procedural elements, and site-related variables influencing socket healing, iv) techniques and effectiveness of alveolar ridge preservation (ARP) procedure, and v) the philosophies and cost-effectiveness of ARP in clinical practice. SOURCES AND STUDY SELECTION: To investigate the dimensional profiles of the alveolar ridge following unassisted healing, an overview of systematic reviews was conducted in February 2024 by two independent reviewers. Four electronic databases were searched in Pubmed, Embase, Web of science and Cochrane Library between 2004 and 2024 to identify all relevant systematic reviews on post-extraction healing. A further manual search of reviews was also conducted. The articles were further reviewed in full text for relevance. The AMSTAR-2 appraisal tool was adopted to assess methodological quality. Current research pertaining to other listed objectives was objectively analysed in narration. DATA: 11 out of 459 retrieved studies were selected and ultimately covered in this review on the dimensional changes of alveolar ridge following natural healing: Seven systematic reviews and four systematic reviews with meta-analyses. The methodological quality of all included reviews was critically low. CONCLUSION: This review thoroughly examines the healing profiles of post-extraction alveolar sockets and highlights the dynamic process with overlapping phases and the inter-individual variability in outcomes. ARP procedure is a potential strategy for facilitating prosthetic site development, while the current evidence is limited. Herein, an individualised and prosthetically driven approach is crucial. Further well sized and designed trials with novel biomaterials need to be undertaken, and the role of artificial intelligence in predicting healing and assisting clinical decision-making could be explored. CLINICAL SIGNIFICANCE: By advancing our understanding of alveolar socket healing and its management strategies, clinicians can make more informed decisions regarding patient and site level assessment and selection, surgical techniques, and biomaterial choices, ultimately contributing to the enhanced healing process with reduced complications and improved quality of life for patients undergoing tooth extraction and dental implant treatments.

Efficacy of Alveolar Ridge Preservation in Periodontally Compromised Molar Extraction Sites: A Systematic Review and Meta-Analysis.

AIM: To investigate the efficacy of alveolar ridge preservation (ARP) in periodontally compromised molar extraction sites. METHODS: An electronic search was performed on 10th November 2023 across five databases, seeking randomised/non-randomised controlled trials (RCTs/NCTs) that included a minimum follow-up duration of four months. The RoB2 and Robins-I tools assessed the risk of bias for the included studies. Data on alveolar ridge dimensional and volumetric changes, keratinized mucosal width, and need for additional bone augmentation for implant placement were collected. Subsequently, a meta-analysis was carried out to derive the pooled estimates. RESULTS: Six studies were incorporated in the present review, and a total of 135 molar extraction sockets in 130 subjects were included in the meta-analysis. ARP was undertaken in 68 sites, and 67 sites healed spontaneously. The follow-up time ranged from 4 to 6 months. The meta-analysis of both RCTs and NCTs showed significant differences in mid-buccal ridge width changes at 1 mm level below ridge crest with a mean difference (MD) of 3.80 (95% CI: 1.67-5.94), mid-buccal ridge height changes (MD: 2.18; 95% CI: 1.25-3.12) and volumetric changes (MD: 263.59; 95% CI: 138.44-388.74) in favour of ARP, while the certainty of evidence is graded low to very low. Moreover, ARP appeared to reduce the need for additional sinus and bone augmentation procedures at implant placement with low certainty of evidence. CONCLUSIONS: Within the limitations of this study, alveolar ridge preservation in periodontally compromised extraction sites may, to some extent, preserve the ridge vertically and horizontally with reference to spontaneous healing. However, it could not eliminate the need for additional augmentation for implant placement. Further, longitudinal studies with large sample sizes and refined protocols are needed.

Motivational Interviewing on Periodontal Treatment Outcomes: A Meta-Analysis.

OBJECTIVES: This systematic review investigated the clinical efficacy of motivational interviewing (MI) in improving oral hygiene and periodontal health in patients with periodontal diseases. METHODS: A comprehensive literature search was conducted across various databases up to May 2023. Randomised controlled trials (RCTs) evaluating the effects of MI on periodontal conditions in patients with gingivitis, periodontitis, and peri­implantitis were included. After data screening, a risk-of-bias assessment was performed using the Cochrane risk of bias (RoB) tool. The meta-analysis was performed using random-effects models. RESULTS: Out of 2108 records screened, 7 RCTs involving 474 patients were included in the qualitative synthesis, with 6 of these studies included in the meta-analysis. Amongst these, 5 studies had a high RoB and 2 had some concerns about bias. Although individual studies reported varied results regarding the effects of MI on different periodontal indices and parameters at different time points, the pooled results revealed no significant difference in the overall effect on plaque level, bleeding on probing, and gingival inflammation between the MI and control groups. In addition, there is insufficient evidence to suggest any significant effect on attachment loss or probing depth. CONCLUSIONS: The current evidence is insufficient to support the effectiveness of MI as an adjunctive intervention for improving oral hygiene and periodontal outcomes. However, these results should be interpreted with caution. Additional high-quality studies with standardised MI interventions are required to derive definite conclusions.

Clinical performance of implant-supported single hybrid abutment crown restoration: A systematic review and meta-analysis.

PURPOSE: To investigate survival rates and technical and biological complications of one-piece screw-retained hybrid abutments in implant-supported single crowns (SCs). STUDY SELECTION: An electronic search was performed on five databases for clinical studies involving implant-supported single hybrid abutment crowns constructed using titanium-base (Ti base) abutments, with at least 12 months of follow-up. The RoB 2, Robins-I, and JBI tools were used to assess the risk of bias for the different study types. Success, survival, and complication rates were calculated, and a meta-analysis was performed to obtain a pooled estimate. Peri-implant health parameters were extracted and analyzed. RESULTS: 22 records (20 studies) were included in this analysis. Direct comparisons between screw-retained hybrid abutment SCs and cemented SCs showed no significant differences in the 1-year survival and success rates. For SCs using a hybrid abutment crown design, their 1-year survival rate was 100% (95% CI: 100%-100%, I2 = 0.0%, P = 0.984), and a success rate of 99% (95% CI: 97%-100%, I2 = 50.3%, P = 0.023) was calculated. No confounding variables significantly affected the estimates. The individual technical complication rate was low at 1-year follow-up. The estimated incidence of all types of complications in hybrid abutment SCs is less than 1%. CONCLUSIONS: Within the limitations of this study, implant-supported SCs using a hybrid abutment crown design showed favorable short-term clinical outcomes. Additional well-designed clinical trials with at least a 5-year observation period are required to confirm their long-term clinical performance.

The role of non-steroidal anti-inflammatory drugs as adjuncts to periodontal treatment and in periodontal regeneration.

Periodontitis is the sixth most prevalent chronic disease globally and places significant burdens on societies and economies worldwide. Behavioral modification, risk factor control, coupled with cause-related therapy have been the "gold standard" treatment for managing periodontitis. Given that host inflammatory and immunological responses play critical roles in the pathogenesis of periodontitis and impact treatment responses, several adjunctive strategies aimed at modulating host responses and improving the results of periodontal therapy and maintenance have been proposed. Of the many pharmacological host modulators, we focused on non-steroidal anti-inflammatory drugs (NSAIDs), due to their long history and extensive use in relieving inflammation and pain and reducing platelet aggregation. NSAIDs have been routinely indicated for treating rheumatic fever and osteoarthritis and utilized for the prevention of cardiovascular events. Although several efforts have been made to incorporate NSAIDs into the treatment of periodontitis, their effects on periodontal health remain poorly characterized, and concerns over the risk-benefit ratio were also raised. Moreover, there is emerging evidence highlighting the potential of NSAIDs, especially aspirin, for use in periodontal regeneration. This review summarizes and discusses the use of NSAIDs in various aspects of periodontal therapy and regeneration, demonstrating that the benefits of NSAIDs as adjuncts to conventional periodontal therapy remain controversial. More recent evidence suggests a promising role for NSAIDs in periodontal tissue engineering and regeneration.

Feasibility and needs for simultaneous or staged bone augmentation to place prosthetically guided dental implants after extraction or exfoliation of first molars due to severe periodontitis.

BACKGROUND: The aim of this study was to retrospectively assess bone volumes, healed ridge topography and possibility to plan prosthetically guided implants (PGI) at least 6 months after extraction or exfoliation of first molars as a consequence of terminal periodontitis (EEFMP). MATERIALS AND METHODS: 45 subjects with stage III-IV periodontitis providing 74 extraction sites (maxillary = 51 and mandibular = 23) were included. The degree of residual periodontal support on each root was assessed by combining periodontal and radiographic data. Digital planning of PGI with 4.8/4.1 mm diameter, 8 mm long, root-form dental implant and need for bone augmentation (BA) were performed using CBCT with a radiographic stent. Possibility of standard implant placement (STANDARD) and need for simultaneous or staged BA were assessed. RESULTS: Planning PGI placement was possible in all cases. For a 4.8 mm diameter implant, STANDARD was possible in 37.8% of the sites, 33.8% required BA at the time of implant placement, and 28.4% required staged BA before PGI. The use of 4.1 mm rather than 4.8 mm diameter implant allowed STANDARD in an additional 8.1% of cases that originally required simultaneous BA/osteotome sinus floor elevation (OSFE). The level of periodontal bone loss did not predict the complexity of implant placement, but significant differences were observed comparing maxillary with mandibular sites. CONCLUSION: PGI planning at sites with first molar loss due to terminal periodontitis is possible but poses great challenge to rehabilitation, often requiring advanced augmentation procedures and sinus augmentation.