Hyperbaric oxygen therapy as an adjunct treatment of periodontitis, MRONJ, and ONJ: a systematic literature review.

OBJECTIVE: To review the available prospective literature on hyperbaric oxygen (HBO) therapy for periodontal conditions. MATERIALS AND METHODS: A comprehensive electronic and manual search was performed to identify clinical studies on adult patients who underwent hyperbaric oxygen therapy for periodontal treatments. A systematic literature search was conducted in PubMed, Cochrane, and Dentistry Oral Sciences Source databases. RESULTS: Fourteen articles were included in the final literature review, of which five were RCTs and 11 were prospective clinical studies. Four studies discussed HBO as an adjunct to nonsurgical treatment of periodontitis, eight reported on HBO and osteoradionecrosis, and one examined HBO in bisphosphonate-related necrosis of the jaws. CONCLUSIONS: HBO has shown superior efficacy compared to antibiotics as a prophylactic measure in preventing osteoradionecrosis (ORN) in patients with a history of high mandibular irradiation. Clinicians should consider referring such patients for HBO therapy before and after tooth extractions. However, for the surgical excision of existing ORN lesions, HBO therapy does not yield significant benefits but does not negatively impact outcomes either. Regarding the treatment of periodontitis patients, the variability among studies prevents definitive conclusions. HBO therapy as an adjunct to SRP in periodontitis treatment produces mixed results. CLINICAL RELEVANCE: This study's clinical relevance lies in its exploration of the potential benefits of HBO for periodontal conditions. Also, it provides clinicians with insights into when and how to integrate HBO therapy into their treatment approaches, particularly for patients with a history of irradiation and those undergoing complex dental procedures.

Treatment of gingival recession defects using non-invasive pinhole technique with propolis application, a case report.

INTRODUCTION AND IMPORTANCE: Despite the considerable surgical techniques that have been done for the root coverage, surgical difficulties, time, and patients' discomfort are still the main obstacles. However, the morbidity associated with the secondary graft sites has generated interest in new modalities to achieve the esthetic and functional requirements without complications, to reach patient comfort and satisfaction. In our study, we used a recent novel surgical technique which is called the pinhole surgical technique as it is a minimally invasive treatment that reverses gingival recession without using donor graft, flap elevation, or sutures. In this study, we also used propolis for root conditioning as it is a natural anti-infective, anti-inflammatory, and anti-oxidant agent. PRESENTATION OF THE CASE: A 58-year-old systemically healthy female patient was referred to our periodontal clinics for the root coverage of the upper left canine and the first premolar which were diagnosed as Class II and Class I Miller's classification respectively. A pinhole surgical technique was done using propolis for root conditioning. A pinhole was created and the gingiva was pushed downwards until reaching the desired position coronally with the aid of collagen strips. Then, propolis was applied again postoperatively to enhance healing. CLINICAL DISCUSSION: Pinhole surgical technique can immediately cover exposed roots without incisions, donor site or flap reflection. In addition, the use of propolis in root conditioning showed positive results. This is due to its antioxidant and anti-inflammatory effects. CONCLUSION: Pinhole surgical technique using propolis is a promising modality that reaches the periodontist ambition for gingival recession defects.