Clinical Advances in Periodontics最新文献

{"title":"Long-term periodontal stability following palliative management of pemphigus vulgaris: A 5-year case report.","authors":"Thaer Alqadoumi, Nabat Davrani, Arthur Oh, Yoon Jeong Kim","doi":"10.1002/cap.70114","DOIUrl":"https://doi.org/10.1002/cap.70114","url":null,"abstract":"<p><strong>Background: </strong>Pemphigus vulgaris (PV) is a chronic autoimmune mucocutaneous disorder that may cause painful oral erosions, mucosal fragility, and impaired oral hygiene, complicating periodontal treatment. This case report describes a staged, minimally traumatic approach to periodontal management in a patient with active PV.</p><p><strong>Methods: </strong>A 49-year-old female with active PV and persistent oral and cutaneous lesions despite systemic therapy presented with severe oral pain, gingival bleeding, and difficulty performing oral hygiene. Initial management consisted of a 2-month palliative botanical oral care regimen, gentle plaque-control instructions, and avoidance of mechanical trauma. Pain was assessed using a 10-point Numerical Rating Scale. Following improvement in oral comfort, scaling and root planing were performed, followed by periodontal re-evaluation and maintenance at 3-month intervals. Periodontal parameters were assessed at baseline and 5 years.</p><p><strong>Results: </strong>Pain decreased from 7/10 at baseline to 2/10 after 1 week and 1/10 following initial therapy. Improved oral comfort facilitated oral hygiene and non-surgical periodontal therapy. Periodontal re-evaluation demonstrated reduced probing depths and gingival bleeding. At 5 years, clinically healthy gingival tissues, minimal bleeding on probing, and stable alveolar bone levels were observed.</p><p><strong>Conclusion: </strong>A staged, minimally traumatic approach facilitated periodontal treatment and long-term periodontal stability in this patient with active PV.</p><p><strong>Key points: </strong>A staged, minimally traumatic approach can enable safe periodontal therapy in patients with poorly controlled pemphigus vulgaris. Palliative topical therapy may provide palliative symptom relief, improving patient comfort and tolerance to oral hygiene and periodontal treatment. Long-term periodontal stability can be achieved with careful treatment sequencing and regular maintenance, even in patients with persistent mucocutaneous disease.</p><p><strong>Plain language summary: </strong>Pemphigus vulgaris is a condition that causes fragile, painful sores in the mouth, making it difficult for patients to eat, brush their teeth, and maintain good oral health. In this case, a patient with poorly controlled disease experienced severe pain and bleeding gums despite medical treatment. A cautious, step-by-step dental approach was used to manage her condition. First, a soothing, non-irritating mouth rinse was prescribed to reduce discomfort and allow the patient to tolerate oral hygiene. After symptoms improved, careful deep cleaning of the teeth and gums was performed, followed by regular maintenance visits every 3 months. The patient showed rapid improvement in comfort within 1 week and was able to eat normally again. Over 5 years, her gums remained stable and healthy with minimal bleeding. This case suggests that a cautious, staged approach can help sa","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the accuracy and usability of artificial intelligence-based language models in responding to common periodontal patient questions.","authors":"Sajad Jahantigh, Reza Amid, Anahita Moscowchi, Fazele Atarbashi-Moghadam, Alireza Akbarzadeh Baghban","doi":"10.1002/cap.70105","DOIUrl":"https://doi.org/10.1002/cap.70105","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence-powered large language models (LLMs) are increasingly used by patients seeking quick information regarding dental and medical problems. Despite their growing popularity, concerns remain regarding the accuracy, clarity, and clinical usefulness of LLM-generated responses. This study aimed to comparatively evaluate the accuracy and usability of widely used LLMs in responding to frequently asked periodontal questions.</p><p><strong>Methods: </strong>In this analytical-comparative study, 15 commonly asked periodontal questions were selected from real patient encounters and administered to ten LLMs in both English and Persian. Responses were evaluated independently and blindly by two board-certified periodontists; disagreements were resolved by discussion or third-reviewer. Each response was rated on a 5-point Likert scale across six criteria: correlation with the question, adequacy, comprehensiveness, clarity/readability, usability for individuals with limited scientific literacy, and scientific accuracy. Statistical analyses included descriptive statistics, Mann-Whitney U test, Kruskal-Wallis test with Bonferroni correction, and univariate ANOVA. Significance level was set at p < 0.05.</p><p><strong>Results: </strong>Significant differences were observed among LLMS (χ<sup>2</sup> = 294.78, p < 0.001). ChatGPT-4.5 with deep search enabled achieved the highest scores across most criteria, while ChatGPT-4o generally underperformed compared with other LLMs. English responses scored significantly higher than Persian (mean 4.25 vs. 3.96; U = 333,058, p < 0.001). Among evaluated criteria, correlation had the highest mean score (4.81), whereas usability for individuals with limited scientific literacy had the lowest score (3.80). LLMs performed significantly better on treatment/prevention questions than on diagnosis/pathogenesis questions. Only ChatGPT-4.5 (deep search) and Grok-3 (deep search) provided citations, with ChatGPT-4.5 referencing more specialized dental sources.</p><p><strong>Conclusions: </strong>LLMs show variable performance in answering frequent periodontal patients' questions, influenced by model architecture, language, question type, and evaluative domain. Although advanced configurations such as deep-search ChatGPT-4.5 offer highly accurate, comprehensive, and well-referenced responses, significant limitations remain particularly in Persian language output and in usability for patients with limited scientific literacy. LLMs may serve as complementary tools for patient communication, but should not replace professional advice. Further development and language-specific optimization are needed to improve global accessibility and reliability.</p><p><strong>Key points: </strong>While AI tools provide highly readable and generally accurate periodontal information, they often lack the clinical nuance required for personalized risk assessment and complex treatment planning. Practitioners sho","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary rehabilitation of Papillon-Lefèvre syndrome using zygomatic implants: A 3-year case report.","authors":"Subasree S, Kaarthikeyan G, Maria Sharon V","doi":"10.1002/cap.70094","DOIUrl":"https://doi.org/10.1002/cap.70094","url":null,"abstract":"<p><strong>Background: </strong>Papillon-Lefèvre syndrome (PLS) is a rare autosomal recessive disorder characterized by palmoplantar keratoderma and rapidly progressive periodontitis, resulting in early tooth loss and severe alveolar bone resorption. Prosthetic rehabilitation in such patients remains a significant clinical challenge due to compromised bone support and functional limitations. This report aims to evaluate the effectiveness of zygomatic implants as part of a multidisciplinary approach for oral rehabilitation in a patient with PLS.</p><p><strong>Methods: </strong>A 17-year-old female with a confirmed diagnosis of PLS presented with partial edentulism and notable psychosocial impairment. Comprehensive clinical and radiographic evaluation informed a staged, multidisciplinary treatment approach. Phase I therapy included thorough periodontal treatment followed by extraction of hopeless teeth was performed. Rehabilitation of the severely atrophic maxilla was achieved using zygomatic implants, while conventional endosseous implants were placed in the mandible. A full-arch implant-supported fixed hybrid prosthesis was subsequently fabricated and delivered. The patient was maintained on a structured follow-up protocol and evaluated over a 3-year period, demonstrating favorable clinical outcomes.</p><p><strong>Results: </strong>At the 3-year follow-up, the implants demonstrated excellent stability with no signs of peri-implant pathology. The prosthesis provided satisfactory esthetic and functional outcomes, significantly improving masticatory efficiency and speech. The patient also exhibited marked improvement in psychological well-being and quality of life.</p><p><strong>Conclusions: </strong>Zygomatic implants represent a reliable and effective treatment modality for rehabilitating patients with severe maxillary atrophy associated with PLS. A multidisciplinary, patient-centered approach is critical for achieving predictable long-term functional, esthetic, and psychosocial outcomes in complex syndromic cases.</p><p><strong>Key points: </strong>Zygomatic implants can be a reliable option to restore function and esthetics when the upper jaw is severely resorbed in Papillon-Lefèvre syndrome. Before considering implants in syndromic periodontitis, it is crucial to first control the periodontal condition and stick to a strict, long-term maintenance plan. In young patients with complex periodontal issues, a coordinated team approach can meaningfully improve chewing, appearance, and overall confidence and quality of life.</p><p><strong>Plain language summary: </strong>Papillon-Lefèvre syndrome is a rare inherited condition that causes severe gum disease and thickening of the skin on the hands and feet. Many patients lose their teeth at a very young age because of rapid destruction of the supporting bone around the teeth. Restoring oral function in these patients is difficult because there is often very little bone remaining in the jaws for conventi","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The skirt-shaped free gingival graft technique for peri-implant keratinized mucosa augmentation: A report of two cases.","authors":"Fan Yang, Yuchen He, Shiwen Zhang","doi":"10.1002/cap.70107","DOIUrl":"https://doi.org/10.1002/cap.70107","url":null,"abstract":"<p><strong>Background: </strong>Free gingival grafting (FGG) is a well-established technique for peri-implant keratinized mucosa (KM) augmentation. However, recipient beds prepared following apically positioned flap surgery are often trapezoidal in shape, whereas palatal grafts are typically rectangular. This geometric mismatch may require graft trimming, reducing usable donor tissue for recipient-site coverage. The skirt-shaped free gingival graft (S-FGG) technique was developed to improve adaptation between the graft and recipient bed. By improving graft-recipient conformity while preserving graft continuity, the technique may increase the effective utilization of donor tissue and extend the coverage achievable from a given graft harvest.</p><p><strong>Methods: </strong>Two patients with insufficient peri-implant KM at mandibular posterior implant sites were treated using the S-FGG technique. A palatal FGG was modified with vertical incisions to create a skirt-shaped configuration and adapted to the recipient site.</p><p><strong>Results: </strong>Both grafts healed uneventfully and integrated successfully with the recipient bed. In Case 1, the postoperative buccal KM width (KMW) measured 6 mm at definitive prosthesis delivery and remained clinically stable during the subsequent 6-month follow-up. In Case 2, the buccal KMW measured approximately 4 mm at 4 weeks and stabilized at approximately 3 mm after tissue maturation. No major postoperative complications were observed.</p><p><strong>Conclusion: </strong>The S-FGG technique appears to be a feasible modification of conventional FGG for peri-implant KM augmentation. By improving graft-recipient conformity, the technique may enhance utilization of available donor tissue. Further clinical studies are needed to evaluate its long-term effectiveness.</p><p><strong>Key points: </strong>The skirt-shaped free gingival graft (S-FGG) technique addresses the geometric mismatch between rectangular palatal grafts and trapezoidal recipient beds, commonly encountered during peri-implant keratinized mucosa (KM) augmentation. By reshaping a conventional FGG while preserving tissue continuity, the S-FGG technique may improve graft-recipient conformity and potentially enhance the effective use of available donor tissue. Clinical application in two cases demonstrated successful graft integration, favorable healing, and stable peri-implant KM during follow-up.</p><p><strong>Plain language summary: </strong>The skirt-shaped free gingival graft (S-FGG) technique reshapes a conventional FGG to better match recipient-site geometry and may increase the effective coverage achievable from a harvested graft while preserving graft continuity.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148984183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guided bone regeneration using titanium mesh and xenogeneic graft alone: Histologic findings and 7-year follow-up.","authors":"Bruno Freitas Mello, Maria Eduarda Bernardo, Gustavo Dos Santos Coura, Márcio de Carvalho Formiga","doi":"10.1002/cap.70101","DOIUrl":"https://doi.org/10.1002/cap.70101","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Guided bone regeneration is a reliable technique for treating alveolar ridge deficiencies, especially in cases of severe maxillary atrophy. This case report describes the clinical management of a partially edentulous female patient presenting horizontal bone resorption in the anterior maxilla.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Horizontal ridge augmentation was performed using a titanium mesh in combination with a xenogeneic particulate bovine bone graft and a resorbable collagen membrane, without the use of autogenous bone. After 10 months of healing, the titanium mesh was removed, and a bone sample was collected using a trephine drill for histological analysis, which confirmed new cortical bone formation with osteocytes in close contact with graft particles. Two implants were then placed, followed by soft tissue conditioning with provisional restorations and final prosthetic rehabilitation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Histological analysis confirmed new cortical bone formation with osteocytes in close contact with graft particles. At the 7-year follow-up, clinical and radiographic assessments demonstrated stable bone volume and successful implant osseointegration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Within the limitations of this case report, the findings suggest that a xenogeneic particulate bone substitute used without autogenous bone, in combination with a titanium mesh and a resorbable collagen membrane, may represent a viable approach for reconstruction of severely atrophic ridges, enabling long-term esthetic and functional outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;Reconstruction of a severely atrophic anterior maxillary ridge was performed using guided bone regeneration with a titanium mesh, a xenogeneic particulate bovine bone graft, and a resorbable collagen membrane, without autogenous bone harvesting. Histological analysis demonstrated new cortical bone formation in close contact with residual graft particles at the time of implant placement. Clinical and radiographic follow-up over 7 years demonstrated maintenance of peri-implant bone levels and stable esthetic and functional outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Severe bone loss in the upper front jaw can make dental implant treatment challenging, particularly when both function and appearance are important. Traditional bone grafting procedures often require harvesting the patient's own bone, which may increase treatment complexity and postoperative discomfort. This case report describes the reconstruction of a severely atrophic anterior maxillary ridge using guided bone regeneration with a titanium mesh, a bovine-derived bone substitute, and a resorbable collagen membrane, without autogenous bone harvesting. After healing, two dental implants were placed to support a fixed prosthetic restoration. Histological analysis showed new bone formation around the graft particles. Clinical and radiographic evaluations over a 7-year follow","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified lip repositioning to correct gummy smile: 8-year follow-up of identical twins.","authors":"Minki Kim, Joseph Samona, Joshua Graham, Maria Latorre Sanchez, Anthony L Neely, Bassam M Kinaia","doi":"10.1002/cap.70106","DOIUrl":"https://doi.org/10.1002/cap.70106","url":null,"abstract":"<p><strong>Background: </strong>Excessive gingival display (EGD) is an esthetic concern resulting in a gummy smile.  EGD affects patients' self-confidence with negative emotional and psychosocial impact. The amount of gingival display is affected by different etiologies, including skeletal, muscular, or dento-alveolar factors. The treatment generally addresses the etiology and includes surgical lip repositioning (LRP), esthetic crown lengthening, or orthognathic surgery. Modified LRP (mLRP) reduces gingival display with less morbidity compared to orthognathic surgery.</p><p><strong>Methods: </strong>The current report highlights an 8-year follow-up of identical 27-year-old twin sisters with EGD. The follow-up showed partial relapse in the original LRP and was retreated using mLRP. Therefore, the twins were retreated using mLRP, which had a lower rate of recurrence and higher patient satisfaction.</p><p><strong>Results: </strong>Both patients demonstrated normal healing with a balanced dynamic smile and stable upper-lip position without EGD.</p><p><strong>Conclusion: </strong>mLRP provided esthetic results with reduction in gummy smiles.</p><p><strong>Key points: </strong>Lip repositioning (LRP) surgery is a less invasive alternative to orthognathic surgery in treating gummy smile patients. Modified LRP may work better long-term than the original approach in treating relapses.</p><p><strong>Plain language summary: </strong>This case report discusses treatment for a gummy smile that can affect patients' confidence by compromising their smile. Identical twin sisters who originally had lip repositioning (LRP) surgery to reduce a gummy smile experienced a relapse after 8 years. The relapse was treated with modified LRP surgery, which shows greater stability and less relapse in reducing the gummy smile compared to conventional LRP surgery. The modified approach significantly reduced the amount of gum display in both sisters and stayed stable through 18 months of follow-up.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148972079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Connective tissue graft wall technique for mandibular Class II furcation defects: Two case reports.","authors":"Ilham Mounssif, Martina Stefanini, Valentina Bentivogli, Diego Bianchelli, Chia Ming Kuo, Matteo Sangiorgi, Claudio Mazzotti, Giovanni Zucchelli","doi":"10.1002/cap.70096","DOIUrl":"https://doi.org/10.1002/cap.70096","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Furcation involvement (FI) represents one of the most challenging conditions in periodontal therapy due to limited accessibility and the progressive interradicular attachment loss that compromises long-term tooth stability. Deep periodontal pockets in molars and premolars often present as combined defects, including horizontal FI and infrabony components. Conventional non-surgical and surgical approaches, including resective procedures, have shown limited long-term advantages. Recently, regenerative strategies have gained increasing interest in the treatment of Class II and selected Class III FI; advances in biomaterials, biologic agents, and tissue management can promote clinical attachment gain while minimizing postoperative recession.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Two patients with mandibular Class II FI were treated using the connective tissue graft (CTG) wall technique, combining a coronally advanced flap (CAF), CTG, and enamel matrix derivative (EMD). Healing was evaluated through clinical and radiographic parameters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Both cases demonstrated resolution of Class II FI (Class 0) at 18-month follow-up, with probing pocket depth reduction from 7 to 3-4 mm, clinical attachment level gain of 3-4 mm at the buccal site, and stable gingival margin position. Bleeding on probing resolved completely in both cases. Radiographic examination showed changes consistent with bone fill in the interradicular area.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Regenerative therapy represents a valuable treatment option for selected furcation defects. The CTG wall technique, combining CAF, CTG, and EMD, achieved furcation resolution, clinical attachment gain, and stable soft tissue outcomes in two mandibular Class II furcation cases. The autogenous CTG may confer additional biologic advantages by enhancing wound stability, space maintenance, and soft tissue phenotype. Controlled clinical trials are needed before routine recommendations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;Regenerative treatment combined with soft tissue augmentation may represent a valuable option for selected mandibular Class II furcation defects. The connective tissue graft wall technique is designed to improve clot stabilization, space maintenance, and soft tissue support around furcation defects. Furcation closure and stable clinical outcomes were observed at 18 months in the two cases presented, supporting further investigation of this approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Furcation defects are areas of bone and tissue loss that develop between the roots of multi-rooted teeth affected by periodontal disease. These defects are particularly difficult to treat because of their complex anatomy and limited accessibility. Traditional treatment approaches often focus on controlling disease progression, while regenerative procedures aim to rebuild lost periodontal tissues. This report describes the treatment of two patients w","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case series of necrotizing periodontal diseases in hospitalized patients: What hasn't been said yet?","authors":"Osmaria Letthycia Carvalho Leal, Fernanda Bortolotto, Mariana Cristina Manoel, Gabriela Silveira de Araújo, Ana Carolina Fragoso Motta, Leandro Dorigan de Macedo, Lara Maria Alencar Ramos Innocentini, Joab Cabral Ramos, Isabel Schausltz Pereira Faustino","doi":"10.1002/cap.70100","DOIUrl":"https://doi.org/10.1002/cap.70100","url":null,"abstract":"<p><strong>Background: </strong>Necrotizing periodontal diseases (NPDs) are uncommon and severe inflammatory conditions characterized by tissue necrosis, painful ulceration, and rapid clinical progression, frequently associated with systemic immunosuppression. Limited data exist regarding their clinical presentation and management in hospital settings.</p><p><strong>Methods: </strong>This retrospective case series included 10 inpatients diagnosed with NPDs across two hospitals. Patients had diverse underlying systemic conditions associated with impaired immune function. Clinical features, diagnostic approaches, microbiological findings, and therapeutic strategies were analyzed and are reported in this paper.</p><p><strong>Results: </strong>All patients exhibited rapid periodontal tissue breakdown with variable extension to adjacent oral mucosa. Unusual opportunistic pathogens, rarely described in the context of NPDs, were identified in several cases. Management included systemic antimicrobial therapy, local periodontal debridement, and, in selected cases, adjunctive antimicrobial photodynamic therapy. Clinical outcomes varied according to systemic status and the timing of intervention.</p><p><strong>Conclusions: </strong>NPDs in hospitalized immunocompromised patients may present atypically and involve non-classical pathogens. Early recognition and individualized multidisciplinary management are essential to prevent disease progression and systemic complications.</p><p><strong>Key points: </strong>Purplish gingival lesions may precede necrosis, and perhaps they could represent an early clinical sign. The oral cavity can act as a reservoir for opportunistic pathogens not traditionally associated with periodontal diseases. Antimicrobial photodynamic therapy may be used as an adjunctive therapy and has shown favorable clinical outcomes in some cases of this series.</p><p><strong>Plain language summary: </strong>Necrotizing periodontal diseases (NPDs) are severe infections characterized by gum necrosis, pain, and rapid destruction of tissues. These conditions are more commonly observed in immunocompromised individuals and may occur in hospitalized patients with systemic diseases. In this study, we describe a series of 10 hospitalized patients who presented with NPD, and we write about the clinical aspect, including the bluish discoloration that is rarely discussed in the literature. Treatment approaches varied according to the clinical conditions of each patient and included broad-spectrum antibiotics and, in some cases, antimicrobial photodynamic therapy (aPDT) as an adjunctive approach. All patients showed clinical improvement after treatment. These findings suggest that early diagnosis and appropriate management are essential in medically compromised patients, and that aPDT may represent a useful adjunctive therapy.</p>","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bimanual instrument suturing technique for periodontal and implant microsurgery: A technical note.","authors":"Mark Gordon, Yu-Chang Wu, Edward Shih-Chang Tseng, Wen-Xiang Zhang, Diego Velasquez-Plata, Hsun-Liang Chan","doi":"10.1002/cap.70098","DOIUrl":"https://doi.org/10.1002/cap.70098","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In the traditional suturing technique, the dominant hand (DH) holds a needle holder, and the non-dominant hand (NH) performs manual ties without the aid of an instrument. In periodontal and implant microsurgery, finer sutures and needles, e.g., 7-0 in International Organization for Standardization units, are used, which could be more difficult to handle with this technique.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and results: &lt;/strong&gt;The bimanual instrument suturing technique (BIST) emphasizing the use of microsurgical instruments in both the DH and NH for tying finer sutures is narratively described, and visualized by a video animation. With BIST, the DH and NH grasp the microsurgical needle holder and tying forceps, respectively. The three-point \"tripod\" support in the hands stabilizes the instruments to improve suture placement precision and reduce hand tremors. Meticulous bimanually coordinated motions assist in stabilizing the flap and control the suture movement with precision and minimal trauma. The primary technical differences and advantages of BIST, compared to the traditional instrumentation technique, are discussed. Wound closure using the BIST principles was demonstrated in three commonly performed periodontal and implant surgeries: guided tissue regeneration, tunneling with connective tissue graft for root coverage, and guided bone regeneration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Structural and standard step-by-step demonstration of BIST is introduced as an efficient method for handling fine needles and sutures during periodontal and implant microsurgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;This technique, utilizing both the dominant and non-dominant hands to tie knots, could potentially enhance the precise placement of the microsutures by allowing better vision and psychomotor coordination and the use of fine finger-wrist motions. It requires hand stabilization and specific needle and suture grasping positions, as well as a specific sequence of needle holder/tying forceps transfers between the hands. As with most new surgical skills, there is a learning curve involved in order to develop finesse. Eye-hand coordination in using two instruments must be developed. The learning curve can be shortened via laboratory technique exercises. Additional instrumentation, i.e., microsurgical tying forceps, is needed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Structured and step-by-step technical standardization and clinical illustration of the bimanual instrument suturing technique were introduced for periodontists to perform minimally invasive microsurgery efficiently. This technique is beneficial for handling hair-thin biotextiles and fine needles by applying both hands to construct surgical knots. This technique could facilitate better visual and psychomotor coordination, delicate wrist/finger motion, and reduce mental fatigue and distraction. This technique requires intentional practice and adherence to standardized step","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single flap approach combined with periosteal pedicle flap as a regenerative procedure: A case report.","authors":"Mattia Severi, Massimo Viola, Leonardo Trombelli","doi":"10.1002/cap.70052","DOIUrl":"10.1002/cap.70052","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Single flap approach (SFA) is a validated procedure for obtaining clinical attachment gain and pocket closure when applied to deep intraosseous defects. However, the presence of an interdental crater as well as the tooth location were associated with a lower rate of primary intention closure, possibly jeopardizing the outcome of the procedure. In order to favor primary closure, the use a periosteum pedicle flap (PPF) was proposed. The present case report showed the effect of a combination of SFA with PPF for the treatment of a severe, isolated intrabony defect at a molar site associated with a deep interproximal crater.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A patient presenting two 6-mm deep bleeding periodontal pockets, in association with an intrabony defect, at the mesio-buccal and mesio-lingual aspect of #19 was treated with the combination of SFA and PPF. Intrabony component of the defect was filled with a combination of deproteinized bovine bone mineral mixed with a gel composed by polynucleotides and hyaluronic acid.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A dehiscence of the primary flap was observed at the interproximal area. Primary closure was still present due to the presence of the underlying periosteal pedicle flap. At the 12-months follow up, pocket closure was observed at both mesio-buccal and mesio-lingual aspects. The radiographical examination showed a substantial remineralization of the infrabony component CONCLUSION: The combination of SFA with PPF may be a promising approach for the treatment of intrabony defects associated with unfavorable conditions of soft tissues located at molar sites.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key points: &lt;/strong&gt;Why is this case new information? The present case reports that single flap approach may be successfully combined with a periosteal pedicle flap to correct intrabony defects associated with unfavorable conditions of soft tissues located at molar sites. What are the keys to successful management of this case? Careful dissection of the flap to isolate and maintain the integrity pf the periosteal pedicle flap Complete debridement of both the intrabony defects and of the root Stabilization of the periosteal pedicle flap above the defect in order to contribute to the primary intention healing What are the primary limitations to success in this case? Absence of unfavorable anatomical conditions possibly jeopardizing the primary closure of the surgical wound Proximity with mental nerve due to possible lesions during the partial thickness dissection PLAIN LANGUAGE SUMMARY: The present paper explored the use of a surgical technique combining a buccal single flap elevation and a periosteal pedicle to treat a periodontal pocket associated with a deep intrabony defect. A buccal split-thickness incision was performed to both visualize the osseous defect and isolate a periosteal pedicle. The defect was debrided and filled with a combination of a xenograft and gel composed of polynucleotides and hyalu","PeriodicalId":55950,"journal":{"name":"Clinical Advances in Periodontics","volume":" ","pages":"676-681"},"PeriodicalIF":1.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13603047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146222309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}