Pacauskienė, Ingrida Marija

Problemos aktualumas ir darbo tikslas. Periimplantito chirurginio gydymo metu, taikant tradicinius titano (Ti) implanto paviršiaus dekontaminacijos metodus, ne visada galima užtikrinti tinkamą išvalymą sunkiai prieinamose implanto vietose. Be to, mechaniniai valymo metodai gali fiziškai pažeisti implanto paviršių o tai neigiamai veikia aplinkinių audinių gijimą, osteointegraciją bei gali skatinti pakartotinę bakterijų kolonizaciją. Siekiant rasti metodą, kuris efektyviai dekontaminuotų Ti paviršių nekeičiant jo topografijos, pradėtas tirti elektrolitinio valymo (EC) potencialas. Šios literatūros apžvalgos tikslas – palyginti elektrolitinį valymą su kitais prieinamais valymo metodais ir įvertinti jų efektyvumą dekontaminuojant Ti paviršių.

Medžiaga ir metodai. Į literatūros apžvalgą įtrauktų publikacijų paieška ir darbo protokolas buvo atliekami laikantis PRISMA rekomendacijų. Publikacijų paieškai pasirinktos keturios internetinės duomenų bazės: PubMed, Cochrane Library, Wiley Online Library, ScienceDirect. Tyrimų atranka vykdoma pritaikant nustatytus tinkamumo kriterijus. Atrinkti straipsniai atitiko reikalavimus: publikuoti nuo 2021-01-01 iki 2026-01-01, in vitro tyrimai, kuriuose buvo vertinamas Ti implantų arba diskų paviršius, užkrėstas mikroorganizmais, siejamais su periimplantitu. Visuose tyrimuose buvo bent po vieną tiriamąją grupę, kurioje taikytas elektrolitinis valymas ir bent trys skirtingi papildomi valymo metodai.

Rezultatai. Į literatūros apžvalgą buvo įtraukti 6 in vitro tyrimai, kuriuose buvo vertinamas elektrolitinis Ti diskų arba implantų valymas bei papildomi mechaniniai, cheminiai ir kiti dekontaminacijos metodai. Elektrolitinis valymas visuose tyrimuose statistiškai reikšmingai sumažino bioplėvelės kiekį ir išlikusių bakterijų gyvybingumą lyginant su kontrole, tačiau palyginus su papildomais valymo metodais, elektrolitinis valymas dalyje tyrimų nepasižymėjo kaip statistiškai pranašesnis už kitus metodus.

Išvados. Visuose nagrinėtuose tyrimuose elektrolitinis valymas su tiekiamu elektrolitu, statistiškai reikšmingai sumažino bioplėvelės kiekį ir išlikusių bakterijų gyvybingumą, nekeisdamas implantų ir diskų topografijos. Tačiau šiai dienai esančių publikacijų duomenų nepakanka, kad būtų galima pateikti tvirtus elektrolitinio valymo pranašumo įrodymus prieš kitas Ti paviršiaus valymo metodikas.

SUMMARY Aim: To compare the effectiveness of injectable (i-PRF) and non-injectable platelet-rich fibrin (PRF) as adjuncts to scaling and root planing (ScRp) in the conservative treatment of periodontitis. Materials & Methods: The systematic review was conducted according to the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols). The review included 9 Randomised Controlled Trials (RCTs), consisting of three studies on non-injectable PRF and six studies on i-PRF, to evaluate their efficacy as adjuncts to ScRp. PubMed, Cochrane Library, and Web of Science were the search databases used to identify studies. Data extraction focused on probing depth (PD), clinical attachment loss (CAL), and secondary parameters. Studies with a minimum of 3 months’ follow-up were included. The data were categorised into three timeframes: short-term (4-8 weeks), mid-term (3 months), and long-term (6 months). Results: Non-injectable PRF consistently provided significant improvements in PD and CAL compared to ScRp alone, especially by the 3-month midterm interval. In contrast, i-PRF shows more varied clinical outcomes, but it demonstrated significant effectiveness in deep pockets (PD > 6 mm). This was associated with increased levels of VEGF and IL-10 in GCF. Both adjuncts enhanced initial healing, but non-injectable PRF appears to offer more long-term clinical stability. Conclusion: PRF and i-PRF offer a clinical advantage over ScRp alone. Non-injectable PRF is more consistent with sustained attachment gains due to its immediate fibrin scaffold. In contrast, i-PRF acts as an adaptive delivery system that polymerises within deep pockets, releasing growth factors. Due to a lack of head-to-head trials, direct comparative evidence remains limited and further trials are required. Keywords: Periodontitis, Scaling and Root Planing, Platelet-rich fibrin (PRF), Injectable Platelet-rich fibrin (i-PRF), Probing Depth, Clinical Attachment Level

Temos aktualumas ir darbo tikslas. Nors vainiko link paslinkto lopo operacija (VPL) su jungiamojo audinio transplantatu (JAT) yra laikoma „aukso standartu“ chirurginiame dantenų recesijų gydyme, atliekant šią metodiką pastebima keletas trūkumų. Taikant šią metodiką, JAT dažniausiai imamas gomurio srityje, todėl neišvengiamai reikalinga antra operacinė (donorinė) sritis. Dėl šios priežasties gali padidėti kraujavimas, pooperacinis skausmas bei bendras paciento diskomfortas. Šie trūkumai paskatino ieškoti alternatyvių medžiagų chirurginiam dantenų recesijų gydymui, pavyzdžiui, trombocitais praturtinto fibrino, kuris yra autogeninė medžiaga, išgaunama iš paciento kraujo. Šio darbo tikslas – palyginti trombocitais praturtinto fibrino ir jungiamojo audinio transplantato efektyvumą dantenų recesijų gydyme, taikant vainiko link paslinkto lopo metodiką. Medžiaga ir metodai. Sisteminė apžvalga buvo atlikta laikantis PRISMA kriterijų. Mokslinių publikacijų paieška vykdyta trijose duomenų bazėse: PubMed, Wiley Online Library, Cochrane Central Register of Controlled Trials (CENTRAL). Pagal PICO(S) sistemą suformuluotas šio darbo probleminis klausimas: ar trombocitais praturtintas fibrinas yra toks pat efektyvus kaip jungiamojo audinio transplantatas chirurginiame dantenų recesijų gydyme? Mokslinių straipsnių rezultatuose buvo vertinami šių klinikinių parametrų pokyčiai: recesijos gylis (RG), keratinizuotų dantenų plotis (KDP), vidutinis šaknies padengimas (ŠP). Rezultatai. Šioje sisteminėje literatūros apžvalgoje nagrinėjami 7 atsitiktinių imčių kontroliuojami tyrimai. Išanalizavus tyrimų duomenis, matoma tendencija, kad geresni RG ir KDP pokyčio rezultatai pasiekti naudojant VPL metodiką su JAT. Nors teigiamas ŠP pokytis stebimas abiejose grupėse, didesnis vidutinis šaknies padengimas nustatytas JAT grupėje. Išvados. Išanalizavus ir įvertinus apžvalgoje analizuojamus klinikinius parametrus, galima manyti, jog TPF nėra statistiškai reikšmingai efektyvesnis nei JAT chirurginiame dantenų recesijų gydyme. Raktiniai žodžiai. Trombocitais praturtintas fibrinas, dantenų recesija.

Relevance and Aim: To systematically evaluate and compare current clinical evidence on the effectiveness of methylene blue and indocyanine green–mediated photodynamic therapy as adjuncts to non-surgical periodontal treatment, compared to scaling and root planing alone.

Materials and method: A comprehensive search was conducted in PubMed, ScienceDirect, and the Cochrane Library, adhering to PRISMA guidelines. Eligible studies were randomized or clinical trials involving human participants, published in English between 2020 and 2025, with a minimum follow-up of three months. Studies had to include patients diagnosed with periodontitis and evaluate the clinical outcomes of MB or ICG mediated antimicrobial photodynamic therapy as adjuncts to SRP.

Results: 12 clinical studies that met the inclusion criteria were selected for qualitative analysis. Most participants in these studies were adults aged 18 to 80 years. The primary outcome measures assessed included probing pocket depth (PPD), clinical attachment level (CAL), and bleeding on probing (BOP). An intergroup comparison was conducted between two treatment modalities: MB aPDT and ICG aPDT, both administered alongside non-surgical periodontal therapy. The evaluation focused on the extent of clinical improvement observed in each group.

Conclusions: Within the limitations of this review, both photosensitizers used as adjuncts to SRP showed beneficial effects, especially in reducing bleeding on probing. However, ICG demonstrated greater improvements in key periodontal parameters, such as clinical attachment level and periodontal pocket depth reduction. These superior outcomes may be due to its enhanced impact on inflammation and bacterial reduction. Furthermore, the studies reviewed indicate that repeated treatment sessions could further increase the clinical effectiveness of this adjunctive therapy.

EVALUATION OF THE EFFECTIVENESS OF INJECTABLE PRF AS AN ADJUNCTIVE METHOD FOR THE CONSERVATIVE TREATMENT OF PERIODONTITIS: A SYSTEMATIC REVIEW SUMMARY

1. Relevance of the problem and aim of the work: To determine if applying injectable platelet-rich fibrin (i-PRF) in conjunction with non-surgical periodontal therapy (scaling and root planing) could result in a significantly greater reduction in probing depth (PD), gain in clinical attachment level (CAL), and improvements in bleeding on probing (BOP) and plaque index (PI) than using SRP alone.
2. Material and methods: The review followed PRISMA principles and the PICO methodology. The literature was searched using PubMed, ResearchGate, and Wiley Online Library, with research ranging from January 2015 to March 2025. Human RCTs comparing SRP + i-PRF vs. SRP alone with at least 3 months of follow-up and outcomes such as PPD, CAL, BOP, and PI were included. Five studies that met these criteria were evaluated.
3. Results: All of the examined trials found that i-PRF groups had better clinical results. The use of i-PRF resulted in larger decreases in probing pocket depth and bleeding on probing, as well as increased clinical attachment levels. There was also an improvement in plaque control and gingival health.
4. Conclusions: i-PRF significantly enhances periodontal healing when used with SRP by promoting tissue regeneration, reducing inflammation, and improving plaque control. While the early findings are encouraging, more long-term and well-structured research is needed to figure out the most effective ways to use i-PRF and to truly understand its lasting benefits. Keywords: Chronic periodontitis, injectable platelet-rich fibrin (i-PRF), scaling and root planing, periodontal regeneration, and non-surgical therapy.

Aim: To explore the effectiveness of indocyanine green photosensitizer in adjunctive Photodynamic Therapy(PDT) of periodontitis, within randomized clinical trials to significantly improve clinical parameters such as periodontal pocket depth, clinical attachment level and bleeding on probing compared to scaling and root planing (SRP) alone. Materials and method: Clinical Review, Pub Med and Science Direct were search databases used to find the relevant articles in regard to the interested topic. The articles observed had to contain keywords applicable relevant to aim and inclusion criteria, such as patients diagnosed with periodontitis. The minimum observation period across all articles is at least 3 months for each study and articles published between February 2016 to May 2021. The articles chosen were required to evaluate the treatment outcomes with ICG-PDT of periodontitis. Results: In this research 5 articles were selected and reviewed in regard to the topic of interest, with most candidates aged between 30 and 70. In these studies, the factors that were investigated were bleeding upon probing, depth of periodontal pockets, and clinical attachment level, with comparisons being made, between the control and test groups. Conclusions were drawn from the results. Conclusion: Within the parameters of this review, indocyanine green photodynamic therapy with scaling and root planing demonstrated promising results in reducing bleeding on probing, but metrics varied in certain studies. Indocyanine green photodynamic therapy with scaling and root planing presents clinical attachment level improvements and decrease in periodontal pocket depth.

Aim: To explore the effectiveness of Photodynamic Therapy (PDT) as a complement to Conservative Treatment (CT) in diabetic patients diagnosed with periodontitis by assessing the statistical significance of its impact on periodontal parameters in comparison with SRP alone Materials and methods: Pub Med, Science Direct and Cochrane Library were search databases used to find the relevant articles. The articles had to contain all keywords applicable to the aim and inclusion criteria, such as diabetic patients diagnosed with periodontitis, articles with a minimum observation period of 3 months and articles published between March 2014 and March 2024. Included articles were required to evaluate the treatment outcomes with PDT. Results: Seven articles were found to be of eligible criteria and most participants were between 40 and 65. The countries the included articles were conducted in were Romania, Brazil and Saudi Arabia. The parameters of HbA1c, probing depth, bleeding on probing and clinical attachment level were explored in all articles between the control and test groups and conclusions were created from the findings. Conclusion: Within the limits of the review, photodynamic therapy in diabetic patients with periodontitis did not show benefits in statistically significant HbA1c reduction compared with conservative treatment alone. When applied, PDT had no statistically significant result on probing depth, bleeding on probing (BOP) and clinical attachment level (CAL) compared to conservative treatment alone.

Aim and objective: The primary aim of this systematic review is to assess and contrast the differences and similarities between traditional smokers and non-smokers regarding the changes in gingival crevicular fluid cytokine patterns and periodontal status.

Materials and methods: A systematic literature review was performed using PubMed, Clinical Key, Ebsco Publishing and ScienceDirect databases. The search strategy involved combining relevant keywords to identify original research articles. The publication of the used articles was no more than 10 years old.

Results: 860 articles were found through a database search using filters, 245 were filtered and inspected, and 5 publications were included in this systematic review based on the eligibility criteria. PD and CAL were among the clinical parameters that were higher in cigarette smokers and non-smokers. PI values were significantly higher among cigarette and ENDS smokers compared to non-smokers, and ENDS users were not significantly different compared to non-smokers. Whereas, in 2 studies, it was significantly higher in ENDS users compared to non-smokers. GI was lower among cigarette and ENDS users compared to never-smokers with periodontitis. Whereas, 1 study found GI value significantly lower in T-cig smokers when compared to E-cig smokers and former smokers with periodontitis. BOP was found to be significantly higher in non-smokers compared to cigarette smokers and ENDS users. Cigarette smoking has higher levels of cytokine markers IL-1β and IL-6 compared to ENDS users and non-smokers. Although electronic cigarette users showed similar periodontal health and inflammatory markers to non-smokers, it indicates slightly less harmful effects on oral health compared to traditional cigarette smoking.

Conclusion: Cigarette smokers exhibit poorer periodontal health compared to non-smokers, and the inflammation present in their saliva increases. The results in electronic cigarette users in the inflammation levels compared to non-smokers are not significant. Therefore, vaping may have less detrimental effects on periodontal health than cigarette smokers. However, to confirm these findings further research needs to be done, and the long-term impact of vaping on periodontal health needs to be researched.

Aim and objective: The main objective of this systematic review is to compare electric toothbrushes and manual toothbrushes in different clinical parameters.

Material and methods: An electronic database was conducted through PubMed to find research articles using a combination of keywords. The articles included were no more than ten years old, and all articles were randomized controlled trials.

Results: The primary search identified 778 articles, of which seven were included in this systematic review. Electric toothbrushes showed high statistical significance in two studies, (Ccahuana-Vazques et al. and Adam R et al.). According to the gingival index were significantly greater with ETB by studies (Gallob et al. and A Ramseier C et al.) Electric toothbrushes were also found to be more effective in reducing BoP, as reported by Ccahuana-Vazquez et al. Although the results of the study by A Ramseier c et al. were not statistically significant, they were different in that they measured cytokines in GCF and showed a decrease in inflammatory markers with the use of electric toothbrushes.

Conclusion: Electric toothbrushes demonstrated greater effectiveness than manual toothbrushes in several key aspects of dental health, such as plaque reduction and gingival health improvement. More research is required to confirm the results, which indicate possible systemic benefits from reduced inflammation (as demonstrated by cytokine levels in GCF).

Problemos aktualumas ir darbo tikslas. Šiuo metu dantų implantų naudojimas yra pripažintas kaip geras gydymo būdas, skirtas atkurti dantis ir kramtymo funkciją pacientams, turintiems dalinius bei pilnus dantų eilių defektus. Tačiau, net ir esant geriems implantų sėkmės rodikliams, komplikacijų neišvengiama. Yra atlikta nemažai tyrimų, kuriais siekiama įvertinti ar keratinizuota gleivinė yra vienas iš apsauginių veiksnių, mažinančių periimplantinių audinių komplikacijų paplitimą. Nors iki šiol atlikti moksliniai tyrimai atskleidžia temos aktualumą, siekiant išsiaiškinti keratinizuotos gleivinės poveikį, tačiau svarba vis dar vertinama kontroversiškai. Šio darbo tikslas nustatyti galimą keratinizuotų dantenų pločio įtaką periimplantinių audinių sveikatai. Medžiaga ir metodai. Mokslinės literatūros apžvalga parengta pagal PRISMA rekomendacijas. Mokslinių straipsnių paieška atlikta elektroninėse duomenų bazėse: PubMed ir Wiley Online Library. Panaudoti straipsnių atrankos kriterijai ir raktažodžių kombinacijos. Atrinkti straipsniai publikuoti nuo 2018.01.31 iki 2023.01.31. Rezultatai. Į literatūros apžvalgą įtraukti 8 tyrimai, iš kurių 6 buvo vienmomentiniai skerspjūvio tyrimai ir dvi perspektyvinės studijos. Bendra analizė parodė, kad keratinizuotos gleivinės trūkumas buvo susijęs su didesniu periimplantito paplitimu ir perimukozito sunkumo lygiu. Nagrinėtų tyrimų rezultatai parodė, kad KDP įtaka zondavimo gyliui, kraštinio kaulo lygiui, apnašų kiekiui, dantenų uždegimo lygiui yra prieštaringai vertinama. Galima pastebėti tendenciją, kad nepakankamas KDP skatina recesijų atsiradimą, didina klinikinės jungties netekimą, kraujavimą zonduojant ir sukelia diskomfortą individualios burnos higienos metu. Išvados. Keratinizuotų dantenų plotis gali turėti įtakos klinikinių ir radiologinių parametrų pokyčiams ir periimplantinių ligų paplitimui, tačiau dėl esamų tyrimų heterogeniškumo ir pašalinių rizikos veiksnių buvimo reikalinga atlikti tolimesnius ilgalaikius stebėjimus. Raktiniai žodžiai: dental implants, gingival recession, peri-implantitis, alveolar bone loss, gingiva, mucositis.