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Aim: This systematic review and meta-analysis evaluated the adjunctive use of hyaluronic acid (HA) in non-surgical periodontal therapy to improve clinical outcomes in patients with moderate-to-severe chronic periodontitis. The aim was to assess its effectiveness in reducing probing pocket depth (PPD), improving clinical attachment level (CAL), and decreasing bleeding on probing (BOP). Methods: Four electronic databases were searched (PubMed, Cochrane Library, Scopus, Web of Science, Grey Literature) for randomized controlled trials (RCTs) published until January 2025 and involving otherwise healthy patients treated with scaling and root planing (SRP) plus HA after at least 12 weeks of follow-up. Risk of bias was assessed using RoB 2.0; data were collected on clinical assessment, microbiological, and biochemical analysis and then analyzed using a fixed-effects or random-effects model considering the high heterogeneity of the included studies, which calls for caution when interpreting the results. Results: Fourteen of the 21 RCTs reviewed underwent a meta-analysis. Compared with SRP alone, the addition of adjunctive HA ≥ 0.8% led to an improvement in PPD, but the reduction in BOP was less consistent. Biochemical markers indicated less inflammation, oxidative stress, and selective antimicrobial activity. Although studies on 0.2% HA are still limited, improvements have been observed in clinical parameters, along with better biochemical and microbiological outcomes in the experimental group compared to the control group. Conclusions: Despite moderate heterogeneity and methodological limitations, the evidence supports the use of HA combined with SRP in periodontal treatment.

Background: This randomized clinical trial compared the effects of topical irrigation with a desiccant agent (HybenX Oral Tissue Decontaminant, HBX) combined with full-mouth ultrasonic debridement as well as scaling and root planing (FMUD-SRP) versus conventional non-surgical periodontal therapy (US-SRP). Methods: Three quadrants per patient with probing pocket depth (PPD) ≥ 5 mm were randomly assigned to (i) the control group (US-SRP only), (ii) test group 1 (HBX + US-SRP at baseline, HBX 1T (one time)), or (ii) test group 2 (HBX + US-SRP across three sessions, HBX 3T (three times)). Clinical parameters included probing pocket depth (PPD), bleeding on probing (BOP), plaque index (PI), gingival recession (REC), and Clinical Attachment Level (CAL), recorded at baseline (Tbase), 45 days (T45d), and 90 days (T90d). Microbiological sampling was conducted for all sites at Tbase, T45d, and T90d to assess periodontal pathogens. HBX-treated sites received gel application for 60 s, followed by a saline rinse and US-SRP. Results: Significant differences were found between groups in PPD (p = 0.04) and CAL (p = 0.02) at T45d versus Tbase, while BOP, PI, and REC showed no significant inter-group differences at T45d. The HBX 3T group demonstrated greater pathogen reduction compared to the control and HBX 1T groups, except for one bacterial species. Conclusions: All treatments improved clinical and microbiological parameters. Even if single and triple applications of HBX showed similar clinical results, the repeated application achieved greater bacterial reduction.

Background: Periodontal disease results from a complex interaction between the microbial biofilm and the host immune response. The aim of this study was to evaluate and compare, in samples of dental plaque in periodontal patients, the presence of periodontal bacteria before and after two different non-surgical treatments: ozone (O3) therapy and a desiccant agent (HybenX, HBX, administered one or three times). Methods: Molecular biology techniques were used to estimate the effect of the two treatments on different periodontal pathogen microorganisms. The presence of Porphyromonas gingivalis, Treponema denticola, Prevotella intermedia, Tannerella forsythia, Actinomyces naeslundii and Aggregatibacter actinomycetemcomitans was investigated by multiplex PCR (mPCR) and quantitative PCR (qPCR) at baseline (T = 0, before oral hygiene), one week (T = 1), two weeks (T = 2), one month (T = 3) and three months (T = 4) after treatment. Results: P. intermedia was the most frequently detected pathogen in the study population, further quantified by qPCR in samples positive to mPCR at baseline (T = 0) and at the end of treatment (T = 4). The qPCR results showed evident decreases in load after treatment with HBX x1, HBX x3 and O3; nevertheless, comparison between groups and between time points (from T = 0 to T = 4) did not show any significant differences (p = 0.3 and p = 0.8). For P. gingivalis, the O3 therapy showed a reduction in detection after two weeks and after one month, while HBX showed a great reduction in its presence when administered three times. Conclusion: Both agents were effective in reducing the presence of the periodontal pathogens in the dental pockets of patients affected by chronic periodontal diseases. In particular, HBX applied three times showed greater improvement compared to a single application.

Background: Gingival recession (GR) is defined as the exposure of the root surface due to the gingival margin shifting apically from the cemento-enamel junction. Current effective management of defects related to GR relies on root coverage periodontal plastic surgery (RCPPS), using the Modified Coronally Advanced Flap (mCAF) with an envelope design. Recent literature also reported the association of different biomaterials to the mCAF procedure. In light of these considerations, a systematic review (SR) was conducted to determine and compare the efficacy of all mCAF adjunctive techniques for the treatment of multiple adjacent GR-type (MAGR) defects. Methods: An electronic search was conducted in 2025 on studies published between 2013 and 2025, using PubMed, Scopus, Web of Science, and Cinahl Complete, to address the focused question: “which is the efficacy of different mCAF adjunctive techniques for the treatment of multiple adjacent GR-type defects, in terms of root coverage (RC), esthetic outcomes, and keratinized tissue (KT) augmentation?”. Randomized controlled trials with a minimum follow-up of 6 months with ≥ 5 patients treated for coverage of MAGR were included. Risk of bias was assessed with RoB 2 Tool. A meta-analysis was performed using RevMan5.4 software and the level of evidence of included studies was analyzed with GRADEPro GDT. Results: A total of 17 studies were included in the SR, 9 of which evaluating mCAF + sCTG (subepithelial connective tissue graft) vs. mCAF adjunctive techniques [Collagen Matrix (CM), xenogeneic acellular dermal matrix (XADM), Platelet-Rich Fibrin (PRF), Enamel Matrix Derivatives (EMD), sCTG harvested double blade scalpel] were then included in the meta-analysis. The primary outcomes of complete root coverage (CRC) and keratinized tissue width variation (ΔKTW) were statistically significant ([CRC: Odds Ratio (OR) 1.70; 95% CI (confidence interval) 1.18, 2.44; p = 0.004]; [ΔKTW: SMD (standardized mean difference) 0.37; 95% CI 0.11, 0.63; p = 0.005]) in favor of mCAF + CTG. Meanwhile, no statistically significant difference was observed in terms of RES. The certainty assessment highlighted relevant results: despite the lack of evidence in the long-term, a high level of evidence showed that sCTG was more effective than XADM in terms of CRC (p = 0.002) and ΔKTW (p = 0.0001). A low level of evidence revealed that sCTG achieved a greater ΔKTW compared to CM (p = 0.0006). Although no significant differences were observed, a low level of evidence suggested that mCAF + EMD and mCAF + sCTG (DBS) may provide good results. To date, only one RCT showed long-term stable results of CTG in terms of RC. Conclusions: The association of sCTG to mCAF demonstrated better results in terms of RC and KTW augmentation in short- and medium-term follow-ups. Long-term studies are needed to confirm the efficacy of the other mCAF adjunctive techniques, considering limitations due to heterogeneity in follow-ups, distribution of techniques analyzed, and different study designs. Registration in PROSPERO (International prospective register of systematic reviews) was performed with ID CRD420251085823.

Background. Transparent aligners are recently introduced orthodontic devices considered promising for the improvement of oral health conditions, in terms of faster treatment times and enhanced comfort, especially if compared with traditional fixed orthodontic therapy. This systematic review aimed to evaluate at-home protocols for proper oral hygiene and aligners cleaning during orthodontic treatment. Methods. A search was conducted using the following four databases: PubMed, Cochrane Library, Web of Science, and Scopus. The systematic review (registered as CRD 42024562215) followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and included prospective studies, randomized controlled trials (RCTs), controlled clinical trials, and in vivo and ex vivo studies; they had to assess treatment with invisible orthodontics compared to treatment with fixed orthodontics, home oral hygiene, or aligner disinfection protocols. The evidence in the studies was evaluated for risk of bias using the RoB-2 (for RCTs and randomized crossover studies) and ROBINS-I tools (for observational studies). Results. Eleven studies were included in this systematic review: four RCTs, four crossover studies, and three cross-sectional observational studies. Seven studies considered patients undergoing orthodontic treatment, whereas four examined orthodontic aligners. The cleaning protocols of the aligners were evaluated based on the analysis of residual biofilm on the thermoplastic surfaces. Studies included were characterized by a low level of certainty, thus further evidence is needed. Conclusions. The most effective protocols entailed a combination of mechanical and chemical agents, suggesting that it is fundamental for patients undergoing aligner treatment to focus on individually tailored home oral hygiene protocols.

Background: This systematic review aimed to assess the outcomes related to the use of antimicrobial photodynamic therapy (aPDT) as an adjunct to non-surgical periodontal treatment (NSPT) of patients affected by periodontitis and with type 2 diabetes mellitus (T2DM). Methods: PubMed, Cochrane Library, Scopus, and Web of Science (core collection) were queried up to January 2025. The PICO question investigated the comparison between T2DM patients undergoing NSPT with or without aPDT, in terms of improvement of clinical parameters. Two independent operators performed the study selection, data extraction, and risk of bias assessment (RoB-2 tool). The meta-analysis examined the reduction in bleeding on probing (BoP) and probing pocket depth (PPD) in sites > 4 mm, reporting mean difference (MD) and 95% confidence intervals (CIs). Results: Among 502 studies retrieved, 15 were finally included in the systematic review and meta-analysis. In T2DM individuals, the adjunct of aPDT to NSPT demonstrated a substantial reduction in BoP and PPD after 3 and 6 months compared to the use of NSPT alone. Conclusions: The outcomes of this systematic review suggest that adjunctive aPDT may provide additional benefit to NSPT in reducing inflammation in T2DM patients with periodontitis, indicating that this combined therapy could represent a potentially useful approach for individuals with T2DM. Review registration: registration in PROSPERO (International prospective register of systematic reviews) with ID CRD42024506295 on 6 February 2024.

Background: As the rehabilitation of the upper anterior maxilla primarily requires high predictability of successful aesthetic outcomes, procedures of immediate implant placement are frequently employed. The aim of this pilot study was to retrospectively evaluate the short-term outcomes of a protocol of immediate implant placement in fresh extraction sockets, followed by immediate non-functional provisional restorations. Methods: Patients were treated for the replacement of maxillary central or lateral incisors, or cuspid teeth with a single-crown locking-taper implant. Clinical and photographic records were retrospectively compared between the teeth prior to extraction (T0) and restorations one year after prosthetic loading (T1). Outcomes were analyzed using the Pink Esthetic Score (PES), according to the patient’s phenotype (thin/thick), with or without the use of connective tissue graft (CTG). Results: The overall mean PES of 25 implants treated was 9.24 ± 2.36 at T0 and 9.60 ± 1.70 at T1. Comparison of groups between T0 and T1 revealed significant PES variations (p = 0.04), with the best and the worst scores, respectively, registered for thin + CTG group (from 7.50 ± 1.91 to 9.75 ± 2.87) and thin group (from 11.33 ± 2.33 to 10 ± 0.89); moderate increases were assessed for thick group (from 8.44 ± 2.40 to 9.44 ± 2.12) and thick + CTG group (from 9.50 ± 1.04 to 9.33 ± 0.81). Conclusions: Within the limits of a short-term analysis of a small number of patients, immediate implant rehabilitation for aesthetic areas of the upper maxilla can be assumed as a safe and predictable protocol. Concomitant use of CTG seems to provide beneficial effects in thin phenotypes, not any additional value in thick phenotypes.

Background/Objectives. With a rapid palatal expander (RPE) is reported to be effective in increasing the volume of nasal cavities, with a restoration of physiological nasal airflow. The purpose of this retrospective clinical study was to evaluate, using Cone Beam Computed Tomography (CBCT), the volumetric changes and airflow velocity changes in the nasal cavities, retro-palatal and retro-glossal airways, resulting from the use of RPE with dental anchorage (group A), also comparing these data with patients non treated with RPE (group B). Methods. Sixteen subjects (aged 9.34 years) with transverse maxillary deficiency and unilateral posterior crossbite were treated with RPE with dental anchorage. Additionally, 8 patients (aged 11.11 years) with juvenile idiopathic arthritis, who did not undergo any orthodontic treatment, were selected as a control group. Expansion was performed until overcorrection was achieved, and the device was left in place for 6 months as fixed retention, followed by another 6 months of night-time removable retention. From the retrospective evaluation, all patients presented two CBCT scans at baseline (T0) and 1-year follow-up (T1). The 3D-Slicer software was used for each CBCT to measure the nasal (VN), retropalatal (VRP), and retroglossal (VRG) volumes, while an iterative Excel spreadsheet allowed for a pilot approximated modeling and calculation of airway flow-related data. Results. Regarding mean age, a statistically significant difference (p = 0.01 *) was found between groups, suggesting that group B is closer to the pubertal growth peak. Analysis between T0 and T1 revealed: (i) a statistically significant increase for volumes VN, VRP and VRG in group A; (ii) a statistically significant increase for VN in group B; (iii) a statistically significant decrease for all variables related to airflow velocity in both groups. Furthermore, comparison between group A and B, regarding variations between T0 and T1, found a statistically significant difference only for VN. Conclusions. Within the limitations of this pilot evaluation, the treatment with RPE revealed promising outcomes for retro-palatal, retro-glossal and nasal volumes, together with clinical changes in airflow velocities.

Aim. To determine cumulative success rate (CSR) of short and ultrashort implants in the posterior maxilla restored with single crowns. Patients and Methods. We performed a retrospective study in 65 patients with 139 implants. 46 were ultrashort and 93 short. Implants were placed with a staged approach and restored with single crowns. Success rate, clinical and radiographic outcomes, and crown-to-implant ratio (CIR) were assessed after three years. Statistical analysis was performed by descriptive and inferential statistics. A log-binomial regression model where the main outcome was implant success was achieved. Coefficients and 95% confidence intervals were reported. Analyses were performed with Stata 13.2 for Windows. Results. 61.54% of patients were female and mean overall age was 51.9±11.08 years old. Overall CSR was 97.1% (95% CI: 92.4–98.9): 97.9 and 95.1% for short and ultrashort, respectively (P value: 0.33). Four implants failed. Covariates were not associated with CSR (P value > 0.05). Regression model showed coefficients correlated with implant success for ultrashort implants (0.87) and most of covariates but none were statistically significant (P values > 0.05). Conclusions. Our results suggest that short and ultrashort implants may be successfully placed and restored with single crowns in the resorbed maxillary molar region.

In patients presenting mucositis, effective sub-gingival debridement is crucial to prevent peri-implantitis. The aim of this randomized study was to assess the three-month (T1) effects of a locally delivered liquid desiccant agent with molecular hygroscopic properties, in association with manual debridement, at sites with peri-implant mucositis. Twenty-three patients presenting at least one implant with no radiographically detectable bone loss, a pocket probing depth (PPD) ≥ 4 mm, and bleeding on probing (BOP), were included. At baseline (T0), patients were randomly assigned to receive the aforementioned desiccant agent before debridement (Test-Group), or a Chlorhexidine 1% disinfectant gel after debridement (Control-Group). Treatments were repeated after seven and 14 days. Peri-implant soft tissue assessment [PPD, BOP, Modified Bleeding Index (mBI), Visible Plaque Index (VPI), and Modified Plaque Index (mPLI)] and microbial sampling were performed at T0 and T1. At T1 the Test-Group presented significantly greater reductions for BOP, mBI, VPI, and mPLI. Concerning the deepest sites of the treated implants, both groups showed statistically significant reductions for BOP and mBI between T0 and T1. Furthermore, the Test-Group exhibited a significant decrease in anaerobic bacteria. Despite these valid outcomes, a complete resolution of the inflammatory conditions was not achieved by any of the groups.