Juodžbalys, Gintaras

Palmitic acid (PA), the most abundant saturated fatty acid in the human body, is implicated in lipotoxicity under hyperlipidemic conditions, with potential consequences for bone metabolism. To investigate its impact on developing bone tissue, this study used an ex vivo organotypic embryonic chick femur model, exposing femora to control (0 µM), low (50 µM), and high (200 µM) PA concentrations. A multimodal approach, integrating microtomographic, histochemical, ultrastructural, and gene expression analyses, was used to assess tissue architecture, matrix composition, mineralization, and molecular adaptations. PA exposure significantly reduced longitudinal femoral growth, as evidenced by decreased femoral length and tissue volume. Gene expression analysis revealed reduced expression of selected osteogenic differentiation-related markers, including RUNX2, BMP2, and SPP1. However, COL1A2 expression was upregulated, correlating with increased collagenous matrix deposition and enhanced mineralization in PA-treated groups. Alcian blue staining further suggested reduced proteoglycan-rich cartilage matrix, particularly at 200 µM PA. Additionally, PA modulated the expression of both pro-inflammatory and anti-inflammatory mediators, along with increased autophagy-associated responses, as suggested by the upregulation of autophagy-related genes and the presence of autophagosomes and autolysosomes. These findings indicate that PA does not simply exert a deleterious effect on bone tissue but rather redirects the developmental trajectory of the organotypic femur by reducing longitudinal growth while promoting collagen-rich matrix maturation and mineral compaction. This response may involve altered cartilage-associated endochondral processes, fatty-acid-driven metabolic adaptation, osteoblast/osteocyte maturation, and autophagy-associated matrix processing under lipid-enriched conditions.

During immediate dental implant placement, regenerative materials are often used to fill the peri-implant space following tooth extraction and implant insertion. One such material gaining popularity in contemporary dentistry is platelet-rich fibrin (PRF). This study aims to examine existing scientific literature to determine if PRF effectively promotes the filling of the peri-implant gap and regeneration of soft tissue in single-unit immediate dental implant placement compared to alternative materials.

Objectives: The purpose of this systematic review and meta-analysis was to evaluate and compare the impact of cigarette smoking, waterpipe smoking, and electronic cigarette vaping on peri-implant clinical outcomes and inflammatory biomarkers in comparison with non-smokers.

Material and Methods: The systematic review was conducted following PRISMA guidelines. A comprehensive literature search was performed using the MEDLINE (PubMed) database. Studies published between October 2015 and October 2025 involving adults with dental implants were included. Random-effects models calculated mean differences (MD) for marginal bone loss and cytokines, and standardized mean differences (SMD) for plaque index and bleeding on probing (BOP).

Results: All smoking modalities were associated with significantly worse peri-implant outcomes than non-smokers. Plaque index increased for cigarette (+5.22 units), waterpipe (+6.31), and e-cigarette users (+1.61). Marginal bone loss was greater in cigarette (+2.16 mm), waterpipe (+1.9 mm), and e-cigarette users (+0.83 mm). Cigarette smokers showed the highest IL-1β (MD = 239.63 pg/mL), while e-cigarette users exhibited elevated IL-1β (+170 pg/mL) and TNF-α (+17.6 pg/mL). A paradoxical reduction in BOP was observed. Subgroup analyses confirmed a risk gradient of cigarette > waterpipe > e-cigarette > non-smoker.

Conclusions: Cigarette smoking exerts the greatest detrimental effect on peri-implant outcomes, followed by waterpipe and e-cigarette use. All modalities promote bone loss, plaque accumulation, and inflammation despite reduced bleeding, likely due to nicotine-induced vasoconstriction. Evidence on waterpipe and vaping remains limited, emphasizing the need for standardized long-term studies.

Objectives: The purpose of this systematic literature review was to evaluate the effects of local simvastatin on alveolar bone regeneration, pain and swelling after tooth extraction, with a minimum follow-up of two months. Material and Methods: A literature search was conducted using PubMed (MEDLINE) database to identify studies published between January 2015 and January 2025 containing a minimum of 20 sockets per study to evaluate the effect of local simvastatin in promoting bone regeneration after tooth extraction. Data synthesis in test and control groups included following parameters: Extraction socket filling material and method, regenerated bone morphology, pain, and swelling. Quality and riskof-bias assessment were evaluated by The Joanna Briggs Institute Critical Appraisal Tools. Descriptive statistics were used. Results: A total of 628 articles were screened, with 6 articles meeting the inclusion criteria and being utilized for this review. A total of 326 sockets with different types were evaluated, the effect of local simvastatin on the morphology of regenerated bone showed statistically significant (P < 0.05) progressive improvement in most cases. Furthermore, pain and swelling assessments revealed a decrease in the test groups compared to the control groups suggesting that local simvastatin may promote bone regeneration while reducing post-treatment discomfort. However, different tools were used to measure regenerated bone morphology pain and swelling, making it hard to draw consistent conclusions about patient comfort. Conclusions: Local simvastatin application promotes bone regeneration without increasing pain or swelling, supporting its use as a safe and effective supplement in regenerative bone treatment after tooth extraction.

Background/Objectives: Statins, widely prescribed for their lipid-lowering properties, also exert pleiotropic effects on various tissues, including bone. However, their osteogenic potential remains poorly defined due to variability in statin type, dosage, and experimental models. This study investigates the osteogenic effects of fluvastatin (FV) and simvastatin (SV) on the ex vivo embryonic chick femur model. Methods: Femora were cultured with logarithmic concentrations (0.1–10 µM) of FV or SV, followed by characterization via microcomputed tomography, histological analysis, and quantitative gene expression. Results: Both statins enhanced osteogenic outcomes at low concentrations (0.1–1 µM), as evidenced by increased bone volume fraction, trabecular organization, collagen matrix maturation, and mineral deposition. Molecular analysis revealed upregulation of key osteogenic markers—RUNX2, SPP1, and COL1A2—with no significant change in chondrogenic markers (SOX9, ACAN), indicating selective activation of osteogenic pathways. In contrast, higher-dose treatment (10 µM) attenuated these effects. Conclusions: These findings underscore the dose-dependent osteoinductive potential of statins and support their application in bone repair strategies within carefully defined therapeutic windows.

Periodontitas – šešta pagal dažnumą liga pasaulyje ir dažniausia dantų netekimo priežastis suaugusių žmonių populiacijoje. Periodontito etiologija siejama su burnos ertmės mikrobiomo disbalansu, pasireiškianti progresuojančiu dantis supančių audinių (dantenų, periodonto raiščio, alveolinio kaulo) netekimu. Klinikiniai periodontito požymiai apima klinikinės jungties netekimą, radiologiškai stebimą alveolinio kaulo destrukciją, zonduojamas dantenų kišenes ir dantenų kraujavimą. Negydoma ar laiku nediagnozuota periodonto patologija lemia ankstyvą dantų netekimą, nors dauguma ligos atvejų gali būti gydomi, taip užkertant kelią dantų netekimui. Pagrindinis periodontologinio gydymo tikslas – sustabdyti ligos progresavimą, atkurti sveikus, stabilius periodonto audinius ir, jei įmanoma, regeneruoti prarastus. Pagrindinė sėkmingo periodontito gydymo sąlyga – efektyvus podanteninio biofilmo pašalinimas. Idealiu atveju, periodontologinio gydymo metu, periopatogeninių mikroorganizmų rūšys, sukeliančios ar palaikančios periodonto audinių infekcijas, turėtų būti pašalinamos arba stipriai sumažinamas jų kiekis. „Aukso standartas“ periodontito gydyme – kruopštus virš ir podanteninio apnašo ir konkrementų pašalinimas ultragarsu ir / ar rankiniais instrumentais. Tačiau šis gydymo būdas turi nemažai apribojimų – ligai pažengus, bakterinį apnašą, susikaupusį giliose kišenėse, furkacijose, intrakauliniuose defektuose, anatominėse šaknų įdubose ir vagelėse mechaniškai pašalinti tampa sunku ar net neįmanoma. Tyrimai rodo, kad, net ir po labai kruopštaus podanteninio konkrementų valymo, ant 30 proc. valytų šaknų paviršių lieka nenuvalytų dantų akmenų ir apnašo, o tai sąlygoja greitą mikroorganizmų rekolonizaciją į jau valytas sritis, o to rezultatas – sumažėjęs gydymo efektyvumas ir kliniškai stebimos negyjančios periodontologinės kišenės. Kadangi periodontitas yra mikroorganizmų sąlygota liga, logiška, kad kartu su mechaniniu instrumentavimu galima naudoti ir papildomas priemones, kurios padėtų eliminuoti ar inaktyvuoti patogeninę mikroflorą tose vietose, kur mašininiai ar rankiniai instrumentai fiziškai pasiekti negali. Pastaruoju metu literatūroje aptinkama duomenų apie „Clean and Seal“ (C&S) metodiką kaip galimą alternatyvą periodontito gydyme. C&S metodas paremtas dviejų papildomų priemonių (natrio hipochlorito (NaOCl) /amino rūgščių gelio (Perisolv®, Regedent AG, Zürich, Switzerland) ir vidutiniškai stabilizuotos didelio molekulinio svorio hialurono rūgšties (xHyA) (Hyadent BG, Regedent AG Zürich, Switzerland) gelio) ir kruopštaus podanteninio instrumentavimo panaudojimo kartu. Iki šiol nebuvo atlikta nė vieno atsitiktinės imties kontroliuojamo klinikinio tyrimo, kuris leistų išsiaiškinti, ar papildomas šių preparatų panaudojimas kartu su podanteniniu instrumentavimu nulemtų geresnius klinikinius bei mikrobiologinius periodontito gydymo rezultatus, lyginant su standartiniu periodontito gydymu, kai naudojamas ultragarsas ir rankiniai instrumentai. Šio darbo tikslas - ištirti klinikinius, mikrobiologinius ir histologinius papildomo NaOCl/amino rūgščių ir xHyA gelių naudojimo kartu su podanteniniu instrumentavimu rezultatus, palyginti juos vien su podanteninio instrumentavimo rezultatis, gydant II–III stadijos A, B laipsnių periodontitą. Nustatyti pagrindiniai darbo uždaviniai:

1. Nustatyti, ar papildomas NaOCl/amino rūgščių ir xHyA gelių kartu su podanteniniu instrumentavimu panaudojimas lemia geresnius klinikinius periodontito gydymo rezultatus (PD sumažėjimą, CAL padidėjimą, BOP sumažėjimą), palyginus su vien podanteniniu instrumentavimu.
2. Nustatyti, ar papildomas NaOCl/amino rūgščių ir xHyA gelių kartu su podanteniniu instrumentavimu panaudojimas lemia geresnius mikrobiologinius periodontito gydymo rezultatus (nustatyti pagrindinių periopatogenų – Aggregatibacter actinomycetemcomitans (A.a), Prevotella intermedia (P.i), Treponema denticola (T.d), Porphyromonas gingivalis (P.g), Tanerella forsythia (T.f) aptikimo dažnį ir bendrą skaičių prieš ir po gydymo), palyginus su standartiniu podanteniniu instrumentavimu.
3. Atlikti histologinę analizę ir nustatyti NaOCl/amino rūgščių ir xHyA gelių poveikį periodonto audiniams.

Objectives: The purpose of this systematic literature review was to establish a correlation between thyroid dysfunctions and periodontium health. Material and Methods: The systematic review was conducted according to PRISMA statement. An electronic search was performed using MEDLINE (PubMed) and Google Scholar databases using a combination of keywords “hypothyroidism’’, “hypothyroidism’’, “thyroid’’, “thyroid dysfunction’’ and “periodontitis’’. The research covered the period from January 1, 2019 and July 1, 2024, included studies written in English, conducted in humans. Results: The results showed that hyperthyroidism can be associated with a higher prevalence of periodontitis due to decreased oral microbiome diversity, serum thyroid-stimulating hormone levels, increased periodontal pocket depth, clinical attachment loss and interleukin-6. Hyperparathyroidism after parathyroidectomy may lead to a slightly higher risk of tooth extraction in the first two years afterward because decreasing lamina dura, increasing periodontal ligament width. And hypothyroidism negatively affects the homeostasis of calcium and phosphorus in the oral fluid and can change the composition of bone minerals. Conclusions: Hyperthyroidism increases the risk of periodontitis by promoting deeper periodontal pockets, reducing oral microbiome diversity, altering alveolar bone structure and elevating inflammatory markers like interleukin-6, which are linked to disease progression. Hypothyroidism worsens periodontal disease by disrupting calcium-phosphorus balance and causing alveolar bone changes, especially in young individuals. Both conditions affect periodontal homeostasis, emphasizing the bidirectional relationship between endocrine and periodontal health. Dentists should monitor thyroid dysfunction, as managing thyroid levels may improve periodontal treatment.

Purpose: To assess the impact of implant placement at different time intervals on the esthetic and clinical outcomes in the esthetic zone. Materials and Methods: A literature screening was conducted in PubMed (MEDLINE), ScienceDirect, and Cochrane databases. Relevant articles were included according to selection criteria and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data was collected from studies published from 2017 to 2022 in English. Results: Nine articles were included, in which a total of 495 implants were placed; 250 of the implants were immediate, 109 were early, and 136 were delayed. Immediate implant placement (IIP) showed no statistically significant difference in Pink Esthetic Score (PES) compared with delayed implant placement (DIP). IIP showed significantly higher PES in comparison with early implant placement (EIP) (mean difference [MD] = –0.76; 95% CI = –1.50 to –0.02; P = .04). The probing depth (PD) was considerably greater for immediate implants than for delayed implants (MD = –0.62; 95% CI = –1.05 to –0.18; P = .005), and the Plaque Index (PI) was statistically greater for early implants compared with immediate implants (MD = 0.15; 95% CI = 0.11 to 0.19; P < .00001). All other soft tissue outcomes showed equal results. The marginal bone loss (MBL) was statistically higher in early implants compared with immediate implants (MD = 0.09; 95% CI = 0.02 to 0.16; P = .02). Conclusions: IIP had significantly superior PES, MBL, and PI results when compared with EIP. The PD was significantly higher for immediate implants compared with delayed implants. All other outcomes showed no significant difference between the three implant groups. It is important to highlight the limitations of this review such as the small number of studies included and the few reports on esthetic indices.

Objectives: This cross-sectional study aimed to evaluate the factors that determine the choice of oral surgeons and periodontists to perform immediate dental implant placement. Material and Methods: An anonymous survey was carried out from January 6, 2024 to February 29, 2024. The questionnaire was distributed online to Lithuanian specialists - oral surgeons and periodontists, who perform implantation procedures. A total of 186 professionals were included in this survey. Chi-square test, its degrees of freedom was used for the analysis of variables. Results: The main reason for refusing immediate implant placement is a periapical lesion greater than 5 mm, reported by 91.7% of oral surgeons and 96.9% of periodontists. Good aesthetics and preservation of anatomical structures are identified as an advantage by 99.2% of oral surgeons and 92.3% of periodontists. In the aesthetic zone, for periodontists, the main criterion for choosing a method is the quantitative and qualitative indicators of the soft tissue of the extraction socket 96.9%, and for oral surgeons - the morphology of the bone walls of the socket 87.6%. Only 43.1% of periodontists and 33.9% of oral surgeons are familiar with and use extraction socket morphology assessment classifications for immediate dental implant placement. Conclusions: Taking into account study’s results, it is recommended to adjust the teaching programs at Universities and to increase the knowledge of specialists performing dental implantation procedures, by carrying out continuous educational programs.

Objectives: This systematic review aims to critically assess the impact of platelet-rich fibrin on maxillary sinus floor augmentation and outline the specific aspects of new bone formation, bone height, implant stability quotient, and Schneiderian membrane thickness. Material and Methods: A systematic review and meta-analysis were conducted, analysing studies from MEDLINE (PubMed), the Cochrane Library, and ScienceDirect databases, published from January 29, 2018 until January 29, 2024 that compared maxillary sinus floor augmentation (MSFA) using bone graft material with and without platelet-rich fibrin (PRF). This review focused on patients 18 years and older who undergone MSFA before the dental implant placement. It systematically examined five studies, encompassing randomized controlled trials, and reported on 112 MSFA procedures conducted in 84 patients. Results: The meta-analysis reveals a marginal significance in new bone formation with PRF, suggesting a trend towards beneficial outcomes that were not statistically significant. No significant impact on bone height was observed. However, a notable improvement in implant stability quotient (ISQ) was recorded, indicating enhanced implant stability with PRF. The Schneiderian membrane thickness did not show significant changes post-treatment with PRF. Conclusions: While platelet-rich fibrin shows promise in enhancing implant stability, its effects on new bone formation and Schneiderian membrane thickness are inconclusive, highlighting the need for further research. Platelet-rich fibrin did not significantly affect bone height. The findings support platelet-rich fibrin’s potential as a beneficial adjunct in maxillary sinus floor augmentation, particularly for implant stability.