Periodontology 2000最新文献

{"title":"Clinical efficacy of platelet‐rich fibrin therapy during oral surgical interventions in cigarette smokers: A systematic review of randomized controlled trials","authors":"Fawad Javed, Muhammad Saad Shaikh, Anton Sculean, Richard J. Miron","doi":"10.1111/prd.70104","DOIUrl":"https://doi.org/10.1111/prd.70104","url":null,"abstract":"Objectives A limited number of randomized controlled trials have assessed the efficacy of platelet‐rich fibrin (PRF) therapy during oral surgical interventions in cigarette smokers. A systematic review of the currently available literature remains undocumented. The aim of this systematic review was to evaluate the clinical efficacy of adjunctive PRF therapy for enhancing wound healing and tissue regeneration and repair during oral surgical interventions in cigarette smokers. Materials and Methods The research question was: “In adult cigarette smokers undergoing OSI, does adjunctive PRF therapy, compared with non‐PRF or conventional comparator interventions, improve wound healing or tissue regeneration and repair?” A literature search was conducted in accordance with PRISMA guidelines. Indexed databases and Google Scholar were searched without time and language restrictions through June 2026. The risk of bias was assessed using the Cochrane Risk of Bias‐2 tool. The certainty of evidence for each clinical outcome was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. Disagreements were resolved via discussion. Results Three randomized controlled trials reported in four publications were included. One trial was reported in two publications describing different outcomes and follow‐up periods. The number of participants in the individual trials ranged from 18 to 102 individuals. Sample‐size estimation was performed in two of the three trials. One trial, reported in two publications, evaluated socket preservation and reported short‐term soft‐tissue healing and postoperative pain outcomes as well as 6‐month radiographic and histologic outcomes. In general, all studies demonstrated that PRF improved healing. One study had a high risk of bias, and the remaining studies demonstrated some concerns. The certainty of evidence ranged from very low to moderate in the included studies. Conclusions The available evidence suggests that adjunctive PRF therapy promotes post‐extraction healing in cigarette smokers; however, its clinical efficacy remains inconclusive given the limited number of clinical trials, methodological heterogeneity, risk‐of‐bias concerns, and low‐to‐moderate certainty of evidence. Further well‐designed, adequately powered RCTs with standardized PRF protocols and long‐term follow‐up are warranted. Clinical Relevance The available evidence suggests that PRF may favor post‐extraction healing in cigarette smokers. Although a lower numerical occurrence of dry socket was reported in PRF‐treated sockets in one RCT, the current evidence is insufficient to establish a preventive effect. Overall, PRF appears promising; however, definitive clinical conclusions remain limited by the small number of trials, methodological limitations, and low‐to‐moderate certainty of evidence.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"53 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ten years and beyond: Long‐term dental implant survival, success, and biological health—A systematic review and meta‐analysis","authors":"Vittorio Moraschini, Krisztina Mikulás, Jamil A. Shibli, João Gabriel S. Souza, Anton Sculean, Rafael Seabra Louro, Carlos Fernando Mourão","doi":"10.1111/prd.70098","DOIUrl":"https://doi.org/10.1111/prd.70098","url":null,"abstract":"Objectives To update dental implant failure and survival estimates beyond 10 years and examine how success definitions and biological outcomes affect interpretation of long‐term performance. Materials and Methods Randomized controlled trials, prospective cohorts, and retrospective cohorts with at least 10 years of follow‐up were included. Failure proportions were pooled by study design using random‐effects models with clustering corrections and prediction intervals. Sensitivity analyses assessed influential studies, risk of bias, surface era, and clustering assumptions. Success, probing depth (PD), marginal bone loss (MBL), and peri‐implantitis were summarized descriptively. Results Thirty‐four studies including 7522 patients and 20 445 implants were analyzed. Pooled failure was 5.1% in prospective studies (95% CI, 3.0%–8.7%), 4.9% in retrospective studies (95% CI, 3.3%–7.1%), and 4.8% in randomized trials (95% CI, 3.2%–7.1%), corresponding to survival of approximately 94.9%, 95.1%, and 95.2%, respectively. Success averaged 85.1% across 14 studies, but definitions varied substantially. Descriptive means were 2.99 mm for PD, 1.30 mm for MBL, and 10.8% for implant‐level peri‐implantitis (range, 3.0%–39.9%). Conclusions Dental implants are highly durable in terms of retention, with approximately 95% survival after 10–25 years. However, high survival does not establish long‐term biological health or true treatment success: success rates were lower and definition‐dependent, and peri‐implant disease showed substantial variability. Retention is therefore a necessary but insufficient endpoint for judging long‐term implant therapy. Clinical Relevance Long‐term assessment should integrate biological, radiographic, technical, functional, and patient‐centered outcomes.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"27 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The osteoimmune cell atlas of peri‐implantitis: A narrative scoping review","authors":"Emilio A. Cafferata, Anton Sculean, Frank Schwarz","doi":"10.1111/prd.70095","DOIUrl":"https://doi.org/10.1111/prd.70095","url":null,"abstract":"Background/Aim Peri‐implantitis represents a complex osteoimmune disorder characterized by dysregulated cellular ecosystems that drive chronic inflammation and accelerated peri‐implant bone loss. Materials and Methods This article was designed as a narrative scoping review to map and integrate the available evidence from transcriptomics, single‐cell RNA sequencing (scRNA‐seq), spatial transcriptomics, flow cytometry, and immunohistochemistry to construct a comprehensive cellular atlas of peri‐implantitis. Key Findings Current evidence suggests that peri‐implantitis lesions contain expanded and activated neutrophil, macrophage, T‐cell, and B‐lineage compartments, together with stromal and vascular cell populations that may contribute to inflammatory amplification and osteoclastogenic signaling. Reported features include CXCR2 <jats:sup>+</jats:sup> neutrophil subsets with NETosis‐associated activity, inflammatory macrophage states, altered Th17/Treg‐related immune responses, and expanded B‐cell/plasma‐cell compartments forming organized adaptive immune niches. Proposed molecular mechanisms include NF‐κB‐related inflammatory activation, CXCL13‐associated adaptive immune organization, NETosis‐related pathways, and RANKL‐mediated osteoclastogenic signaling. However, several of these pathways remain incompletely validated in human peri‐implantitis tissue. Critical knowledge gaps include limited direct evidence for NLRP3 inflammasome activation, uncharacterized type I interferon signaling, unresolved hierarchies of cellular RANKL sources, and limited functional data for rare immune populations. Conclusions The peri‐implantitis osteoimmune microenvironment constitutes a highly organized, self‐reinforcing inflammatory ecosystem. Progress toward precision therapeutic strategies requires spatial multiomics at subcellular resolution, longitudinal human studies, and functional ex vivo validation models to interrogate the self‐sustaining circuits identified here.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"53 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential impact of persistent hyperglycemia on platelet‐rich fibrin mediated regeneration of periodontal and peri‐implant tissues: Biological mechanisms and clinical implications","authors":"Fawad Javed, Anton Sculean, Richard J. Miron","doi":"10.1111/prd.70094","DOIUrl":"https://doi.org/10.1111/prd.70094","url":null,"abstract":"Background Platelet‐rich fibrin (PRF) has emerged as a widely utilized autologous biomaterial in periodontal and peri‐implant regenerative therapy owing to its ability to provide a three‐dimensional fibrin scaffold enriched with platelets, leukocytes, growth factors, and cytokines. However, persistent hyperglycemia (as observed in patients with poorly controlled diabetes mellitus) induces oxidative stress in oral and systemic tissues and impairs angiogenesis and extracellular matrix remodeling. Aim To provide an overview of the potential impact of persistent hyperglycemia on &lt;jats:styled-content style=\"fixed-case\"&gt;PRF&lt;/jats:styled-content&gt; ‐mediated regeneration of periodontal and peri‐implant tissues, and to gain an in‐depth understanding of the underlying biological mechanisms and their clinical implications. Materials and Methods The research question was “Does a state of persistent hyperglycemia affect PRF‐mediated periodontal and peri‐implant tissue regeneration?” Indexed databases and Google Scholar were searched without time and language barriers up to and including August 2026. The pattern of the present study was customized to summarize the pertinent studies. Results Evidence evaluating the impact of persistent hyperglycemia on PRF remains limited and is largely confined to ex vivo, in vitro, and observational studies. Nevertheless, the available data consistently suggest that poorly controlled diabetes mellitus is associated with alterations in PRF architecture, including increased porosity, reduced clot dimensions, diminished PRF yield, and a less organized fibrin meshwork. Limited evidence also indicates that although growth factor release from PRF may be preserved under hyperglycemic conditions, PRF obtained from individuals with well‐controlled diabetes mellitus shows structural and biological characteristics that closely resemble those observed in systemically healthy individuals. This suggests that regenerative capacity may be preserved when glycemic levels are adequately controlled. This supports the idea that the regenerative capacity of PRF may be preserved when glycemic levels are adequately maintained. Conclusions Glycemic control appears to be a key determinant of PRF quality and regenerative outcomes. Nevertheless, the lack of prospective clinical studies evaluating direct regenerative outcomes highlights the need for well‐designed clinical trials to clarify the influence of persistent hyperglycemia on PRF‐mediated periodontal and peri‐implant regeneration. Clinical Relevance Persistent hyperglycemia may compromise the regenerative potential of PRF primarily through alterations in fibrin architecture, which may further lead to faster clot breakdown and impairment of biological responsiveness within a chronically inflammatory environment. However, limited data to date suggest that effective glycemic control and patient education may help preserve PRF characteristics favorable for periodontal and peri‐implant tissue regenerat","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"156 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiresorptive therapy influence on peri-implant diseases: Clinical implications and osteoimmunological perspectives.","authors":"Emilio A Cafferata, Frank Schwarz, Reinhard Gruber","doi":"10.1111/prd.70085","DOIUrl":"https://doi.org/10.1111/prd.70085","url":null,"abstract":"<p><strong>Background/aim: </strong>Antiresorptive therapy represents a cornerstone in the management of osteoporosis and cancer-related bone disease through suppression of osteoclast-mediated bone resorption. As implant therapy becomes more common in aging populations, clinicians increasingly encounter patients receiving these medications, thus making their impact on peri-implant tissues clinically relevant.</p><p><strong>Materials and methods: </strong>This narrative review critically examines clinical evidence on implant survival, peri-implant bone stability, peri-implantitis progression, and treatment considerations in patients receiving antiresorptive therapy, while integrating mechanistic insights.</p><p><strong>Results: </strong>Evidence suggests that implant survival and marginal bone loss in osteoporotic patients are generally comparable to untreated individuals, indicating that suppression of bone resorption does not inherently compromise osseointegration. However, these outcomes may not fully reflect peri-implant tissue dynamics. Antiresorptives alter osteoclast functions and bone remodeling, potentially affecting the osteoimmune balance required to adapt to mechanical and oral microbial challenges. While these effects may remain subclinical under healthy conditions, they may become relevant during chronic peri-implant inflammation or repeated surgical interventions, where remodeling demands are increased. Altered remodeling may result in lesion persistence, impaired structural recovery, and late complications. Although medication-related osteonecrosis of the jaw remains rare, antiresorptives may modify osteoimmune interactions within inflamed tissues. Therefore, peri-implantitis may act as a contextual modifier influencing healing outcomes.</p><p><strong>Conclusions: </strong>Antiresorptive therapy should not be regarded as an absolute contraindication to implant therapy in appropriately selected patients, particularly those receiving osteoporosis-dose regimens. However, chronic peri-implant inflammation, repeated surgical intervention, and high-dose oncologic antiresorptive exposure may impair osteoimmune adaptation and increase susceptibility to delayed healing and MRONJ-related complications.</p><p><strong>Clinical relevance: </strong>Early control of peri-implant inflammation, individualized risk stratification, and strict supportive maintenance should be considered central components of clinical management in antiresorptive-exposed patients.</p>","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":" ","pages":""},"PeriodicalIF":17.8,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From mouth to brain: Linking periodontal and peri-implant dysbiosis to systemic inflammation and neuropathology.","authors":"Emilio A Cafferata, Frank Schwarz, Jaime Díaz-Zúñiga, Alpdogan Kantarci","doi":"10.1111/prd.70075","DOIUrl":"https://doi.org/10.1111/prd.70075","url":null,"abstract":"<p><strong>Background/aim: </strong>Growing evidence suggests that imbalances occurring within the human microbiota and deregulation of the host immune response may play a significant role in the development of neurodegenerative diseases.</p><p><strong>Materials and methods: </strong>A comprehensive narrative review of the latest experimental, clinical, and epidemiological insights was conducted to explore the associations among oral dysbiosis, including periodontitis and peri-implantitis, a low-grade inflammatory phenotype, and biological pathways that may contribute to the onset of neuroinflammation and neuropathologies.</p><p><strong>Results: </strong>Periodontitis is a chronic inflammatory non-communicable disease driven by subgingival dysbiosis, increasingly linked not only to progressive bone and tooth loss but also to a broad range of systemic chronic non-communicable diseases. Indeed, the persistent burden of deregulated chronic inflammation not only exacerbates periodontal tissue destruction but also promotes a low-grade inflammatory phenotype that may predispose patients to a spectrum of degenerative diseases, such as neurodegenerative disorders. In contrast, evidence regarding peri-implantitis remains comparatively limited and indirect, although emerging data indicate potential systemic inflammatory and cognitive implications.</p><p><strong>Conclusion: </strong>Elucidating the intricate interactions between oral dysbiosis, periodontal diseases, chronic inflammation, and neurodegeneration is essential for understanding oral health's systemic implications for neurodegenerative and age-related diseases. Current evidence supports an association between oral dysbiosis, chronic oral inflammation, and pathways relevant to neurodegeneration, particularly for periodontitis. However, important knowledge gaps remain, especially concerning peri-implant diseases, where human data are limited.</p><p><strong>Clinical relevance: </strong>Effective management strategies targeting periodontal and peri-implant dysbiosis and restoring the immune imbalance may offer novel avenues for promoting healthy aging and preventing neuropathic morbidities.</p>","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":" ","pages":""},"PeriodicalIF":17.8,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148983092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and clinical indications of adjunctive chlorhexidine mouthrinses in nonsurgical and surgical periodontal therapy: A systematic review and meta‐analysis","authors":"Luca Coccoluto, Luca Antonelli, Ivana Crescenzi, Marco Crescenzi, Roberto Rotundo","doi":"10.1111/prd.70087","DOIUrl":"https://doi.org/10.1111/prd.70087","url":null,"abstract":"Aim To evaluate the adjunctive effects of chlorhexidine (CHX) mouthrinses in nonsurgical and surgical periodontal therapy on periodontal parameters and postoperative wound healing, and to define their clinical indications. Materials and Methods Two PICOS frameworks guided the inclusion of randomized controlled trials assessing CHX versus placebo/no rinse as an adjunct in nonsurgical and surgical periodontal therapy. A systematic search was conducted in Medline, EMBASE, Cochrane Library, Scopus, and Web of Science. Random‐effects meta‐analyses were performed for nonsurgical therapy; heterogeneity precluded quantitative synthesis for surgical outcomes. Risk of bias, sensitivity analyses, influence diagnostics, and GRADE assessments were applied. Results Twenty RCTs were included. In nonsurgical therapy, CHX produced statistically significant but clinically modest improvements in probing pocket depth (PPD) (MD −0.30 mm; 95% CI −0.50 to −0.09) and BOP (MD −9.35 percentage points; 95% CI −14.17 to −4.53), while no meaningful benefit was observed for CAL. Prediction intervals indicated limited reliability of PPD effects. In surgical therapy, CHX was associated with improved early postoperative inflammatory control, without evidence of superior long‐term wound healing. Conclusions Adjunctive CHX in nonsurgical periodontal therapy provides modest but outcome‐specific benefits, mainly limited to inflammatory parameters, with no clear additional effect on attachment outcomes. In surgical therapy, the qualitative analysis seems to support early postoperative plaque control and inflammation control, while evidence for an effect on later healing remains limited.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"59 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148964277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding exosomes: A history of EV-erything.","authors":"Richard J Miron, Paras Ahmad, Anton Sculean","doi":"10.1111/prd.70092","DOIUrl":"https://doi.org/10.1111/prd.70092","url":null,"abstract":"<p><strong>Background: </strong>Extracellular vesicles (EVs), including exosomes, have emerged as fundamental regulators of cell-to-cell communication and are increasingly recognized for their therapeutic and diagnostic promise. While EV research has expanded remarkably over the past two decades, the discipline is rooted in a much longer history of observations, conceptual progress, and technological innovations that gradually transformed the comprehension of these nanosized particles. This review offers a historical perspective on the evolution of EV biology, underscoring the pivotal discoveries, researchers, and community-mediated initiatives that have shaped the contemporary domain.</p><p><strong>Methods: </strong>A narrative review of the literature was conducted to assess major milestones in EV research, from the earlier descriptions of cell-free particulate material to modern progress in EV biology, standardization, and translational medicine. Particular emphasis was placed on landmark investigations that redefined the biological importance of EVs and on the development of international frameworks that enhanced reproducibility and methodological rigor.</p><p><strong>Results: </strong>Early studies characterized EV-like particles as sedimentable plasma components or cellular waste, culminating in Peter Wolf's description of \"platelet dust\" in 1967. Subsequent research by Crawford, Johnstone, Stahl, Raposo, Ratajczak, and others established EVs as bioactive structures contributing to vesicle biogenesis, antigen presentation, and horizontal gene transfer of genetic information. Progress in particle characterization, molecular profiling, and imaging approaches further demonstrated EVs as intricate carriers of proteins, lipids, metabolites, and nucleic acids capable of mediating diverse physiological and pathological mechanisms. In parallel, the establishment of the International Society for Extracellular Vesicles (ISEV) and the successive MISEV guidelines offered a pivotal foundation for standardization, transparency, and reproducibility across the discipline.</p><p><strong>Conclusion: </strong>The history of EV research reflects a remarkable transition from observations of poorly understood extracellular particles to the recognition of EVs as key modulators of biological communication and potential therapeutic systems. As technological capabilities, standardization efforts, and translational applications continue to advance, EVs are poised to play an increasingly important role in the future of precision medicine.</p>","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":" ","pages":""},"PeriodicalIF":17.8,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding extracellular vesicles in antiaging","authors":"Paras Ahmad, Nathan E. Estrin, Anton Sculean, Richard J. Miron","doi":"10.1111/prd.70070","DOIUrl":"https://doi.org/10.1111/prd.70070","url":null,"abstract":"Background Aging is a multifactorial process marked by gradual cellular dysregulation, regulated by hallmarks, including genomic instability, mitochondrial dysregulation, and chronic inflammation. Extracellular vesicles (EVs), especially exosomes, have emerged as pivotal mediators of cell‐to‐cell communication with potential roles in both enhancing and alleviating aging. This review aimed to synthesize existing literature on the mechanistic and therapeutic role of EVs in aging and age‐associated disorders. Methods A comprehensive narrative review was performed utilizing Web of Science, Scopus, and PubMed databases. Studies assessing EVs in aging, cellular senescence, regenerative biology, and age‐related disorders were included. Both preclinical and clinical studies were qualitatively examined, emphasizing EV origin, molecular pathways, and treatment outcomes. Results EVs derived from young or stem cells show strong antiaging features across multiple systems, such as the immune, musculoskeletal, cardiovascular, and nervous systems. These impacts are regulated via mitigating cellular senescence, reestablishing mitochondrial activity, restoring mitophagic and autophagic signaling, regulating inflammatory signaling, and improving tissue regeneration. Contrarily, EVs from diseases or aged cells improve pro‐aging phenotypes, such as inflammation, fibrosis, and metabolic dysregulation, underscoring their context‐mediated duality. Preclinical evidence consistently supports EV‐mediated therapies; nonetheless, clinical translation remains restricted owing to heterogeneity in EV subpopulations, lack of standardized isolation protocols, and variability in bioactive payload. Conclusion EVs represent promising therapeutic agents and biomarkers in aging biology, with the potential to regulate multiple hallmarks of aging concurrently. Prospective research should prioritize standardization, targeted bioengineering, and rigorous clinical validation to allow successful antiaging interventions.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"51 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148858736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing the effectiveness of surgical therapy of peri‐implantitis","authors":"Ausra Ramanauskaite, Wenije Zhou, Emilio A. Cafferata, Frank Schwarz","doi":"10.1111/prd.70052","DOIUrl":"https://doi.org/10.1111/prd.70052","url":null,"abstract":"Background Surgical therapy is required in the majority of peri‐implantitis cases due to the inconsistent efficacy of non‐surgical approaches. Although surgical treatment generally offers higher predictability, reported success rates vary widely. Aim To review the available evidence on the factors influencing the outcomes of peri‐implantitis surgical therapy, including surgical technique, implant‐site characteristics, and patient‐related conditions. Materials and Methods This narrative review is based on a literature search conducted in three electronic databases to identify relevant studies published between January 2010 and November 2025. Results Surgical factors: The adjunctive use of reconstructive measures improves radiographic defect fill and may help maintain soft‐tissue levels, although no clear benefits have been demonstrated in the resolution of clinical signs of inflammation compared with non‐reconstructive approaches. Contained intrabony defects (3‐ and 4‐wall) consistently demonstrate more favorable outcomes of reconstructive therapy compared with non‐contained defects (1‐ and 2‐wall). Reconstruction protocols that incorporate slowly resorbing bone substitutes may lead to more favorable outcomes compared with autogenous bone. No definitive conclusions could be made regarding the optimal flap design, postoperative healing mode (i.e., submerged versus non‐submerged), or the benefits of adjunctive membranes, systemic antibiotics, or additional use of biologics. Overall, the effectiveness of surgical peri‐implantitis treatment is associated with the surgeon's level of experience. Implant‐site‐related factors: Initial disease severity characterized by extensive bone loss, suppuration, deep probing depths, rough implant surfaces, and persistent bleeding after surgery have been identified as major factors compromising treatment success. Conversely, the presence of keratinized mucosa appears to enhance the outcomes of reconstructive peri‐implantitis therapy. Emerging evidence points to an association between macrophage polarization and the outcomes of surgical peri‐implantitis treatment. Patient‐related factors: Current evidence underscores the essential role of patient adherence to supportive postoperative care in maintaining the results achieved surgically. Findings concerning the influence of a history of periodontitis, smoking status, and gender remain inconsistent. Conclusions Outcomes of surgical peri‐implantitis treatment are determined by a complex interplay of defect morphology, disease severity, implant surface characteristics, surgical expertise, and patient adherence to supportive care. Clinical Relevance Clinically, careful case selection, defect‐specific surgical planning, and strict postoperative maintenance are essential to enhance predictability and long‐term stability.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"74 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148858739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}