Relevance. The rising prevalence of periodontal disease underscores the need for innovative diagnostic and therapeutic approaches. Mechanical debridement of the biofilm remains the cornerstone of periodontal treatment. However, systemic antibiotics are recommended for patients experiencing rapidly progressing periodontal attachment loss who do not respond adequately to conservative therapy. Despite their widespread application, antibiotics do not always achieve the desired outcomes. In such scenarios, adjuvant therapies that enhance the efficacy of standard treatment against infectious agents become particularly important. Oral enzyme combination (OEC) has emerged as a valuable adjunct in this context. Objective: to review the available data on oral enzyme combination (OEC) drugs and assess their potential application in clinical practice for managing periodontal disease.

Materials and methods. A total of 939 publications from 2010 to 2024 were identified through searches in PubMed and eLIBRARY. Following inclusion and exclusion criteria, 10 publications, including randomized clinical trials, were selected for analysis. The search was conducted using the following keywords: bromelain, trypsin, rutin, periodontal disease, enzyme therapy in dentistry, and systemic antibiotics: bromelain, trypsin, rutin, periodontal disease, enzyme therapy in dentistry, and systemic antibiotics.

Results. Oral enzyme combination (OEC) drugs reduce inflammatory activity, limit pathological manifestations of autoimmune and immune complex processes, decrease vascular wall permeability, and enhance antibiotic concentration at the site of inflammation. The efficacy of oral combinations of proteases, such as bromelain (a proteolytic enzyme), and other components like rutin (a glycoside combining the flavonol quercetin and the disaccharide rutinose), has been demonstrated in dental practice. These combinations have shown benefits in relieving pain, reducing swelling and inflammation, enhancing the effectiveness of antibacterial therapy, and minimizing its side effects.

Conclusion. With their potent proteolytic activity and low cytotoxicity, systemic enzyme therapy drugs have become widely accepted as adjuvants to antibiotic therapy, enhancing its effectiveness. The combination of antibiotics and systemic enzyme therapy has shown superior outcomes compared to antibiotics alone, indicating its potential efficacy in the treatment of periodontal disease.

Relevance. Limited scientific literature exists on the compositional relationship between dentinal fluid and gingival crevicular fluid, as well as their potential interaction. Objective. This study aims to determine the origin of gingival crevicular fluid, compare its composition with that of dentinal fluid and gingival capillary blood, and assess the potential for their interaction.

Materials and methods. This study analyzed three biological fluids: dentinal fluid, gingival crevicular fluid, and gingival capillary blood. A total of 35 volunteers participated in the study. The biological fluids were examined using an infrared microspectrometer at the Australian Synchrotron. Additionally, the microrelief of the enamel in extracted intact teeth, removed for orthodontic reasons, was assessed using a JEOL JSM-6380LV scanning electron microscope (Japan).

Results. Dentinal and gingival crevicular fluids exhibit a complex composition comparable to that of blood plasma. The findings reveal spectral modes unique to the infrared (IR) spectra of these fluids. Based on this evidence, it is hypothesized that dentinal fluid may infiltrate the gingival sulcus via dentinal and enamel tubules. During this passage, the fluid interacts with hydroxyapatite crystals, resulting in alkalization. Furthermore, the urea concentration in dentinal fluid is 2.3 times higher than in gingival crevicular fluid, which likely contributes to an increased urea concentration in gingival crevicular fluid diffusing from the gingival papilla.

Conclusion. Given the newly discovered potential for dentinal and gingival crevicular fluid mixing, we propose refining the terminology by replacing the term "gingival crevicular fluid" with " dentogingival fluid."

Relevance. The wide range of predisposing factors and clinical manifestations of dentin hypersensitivity (DH) underscores the importance of prognosticating its development in dental patients. Objective. To develop a novel classification of dentin hypersensitivity, to substantiate the relevance of prognostic criteria for DH in dental patients, and to evaluate the effectiveness of their implementation.

Materials and methods. The study enrolled 98 patients, who were allocated into three groups: one control group and two experimental groups. Clinical parameters were assessed over a 12-month observation period.

Results. The proposed classification of DH enabled the targeted identification of prognostic criteria and the selection of diagnostic and therapeutic measures, resulting in an improvement in treatment efficacy by more than 46%.

Conclusion. Long-term follow-up confirmed the effectiveness of the developed comprehensive treatment approach for DH in 96% of dental patients.

Relevance. Currently, temporomandibular disorders (TMD) are highly prevalent. During the initial dental consultation and examination, special attention should be given to the diagnosis of TMD, as complications may arise following prosthetic treatment, particularly after extensive procedures, which may manifest as newly emerging or previously undiagnosed TMD disorders. The implementation of modern digital technologies enhances the accuracy and effectiveness of TMD diagnostics and treatment, ensuring compliance with established protocols, including the use of occlusal stabilization appliances (OSA).

Objective. To assess the effectiveness of a modern digital treatment protocol for designing an occlusal stabilization appliance, followed by temporary fixed dental restorations, in the treatment of patients with TMD involving both joint and myofascial dysfunction, with functional diagnostic monitoring.

Materials and methods. A clinical dental examination was performed on 78 individuals. Based on inclusion and exclusion criteria, 20 individuals diagnosed with TMD were assigned to the main group, while 20 individuals without TMD were included in the control group. Participants in the main group underwent cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ). Both groups underwent electrognathographic recording (EGG) and surface electromyography (sEMG) using a functional diagnostic system. Electrognathography was used to track and analyze the trajectory and range of eccentric mandibular movements, while angular parameters relative to the horizontal plane were derived from the recorded motion data. Surface electromyography was employed to assess bioelectrical activity, as well as the symmetry and synergy of the masticatory and temporalis muscles. The data collected from the main group were analyzed at different treatment stages and compared with the corresponding data from the control group. Occlusal stabilization appliances and temporary fixed dental restorations were fabricated using milling technology, incorporating CBCT imaging, intraoral scanning, and occlusal registration following transcutaneous electrical nerve stimulation (TENS).

Results. In the main group, surface electromyography (sEMG) during the relative physiological rest test revealed a 60.3% average reduction in the bioelectrical activity of the masticatory muscles compared to baseline values before treatment. During the maximum voluntary clenching test, an increase in muscle symmetry of 89.5% on average was observed, while muscle synergy improved by 61% compared to baseline values. According to electrognathographic data, after prosthetic treatment, the main group demonstrated an average 71% increase in the range of eccentric occlusal movements of the mandible, as well as a 77% average reduction in the variability of angular parameters of eccentric occlusal movements compared to baseline values.

Conclusion. The use of an advanced digital treatment protocol for temporomandibular disorders (TMD) involving both joint and myofascial dysfunction, based on individualized parameters for modeling occlusal stabilization appliances and temporary fixed dental restorations, as well as functional diagnostics and outcome monitoring, ensures stable and reliable rehabilitation outcomes for patients.

Relevance. Gingival recession is a periodontal condition characterized by the apical displacement of the gingival margin and subsequent root surface exposure, which may remain stable or progress over time. This study aimed to assess the prevalence of gingival recession in the maxilla of patients with occlusal plane rotation. The authors present findings on the gingival margin status of maxillary teeth in individuals with transverse occlusal plane rotation.

Materials and methods. The gingival margin status of 106 patients with transverse occlusal plane rotation in the maxilla was evaluated. Facial photometry was performed, and the angle of occlusal plane rotation was identified using rapid diagnostic techniques. The Miller classification system was employed to assess the severity of gingival recession.

Results. The analysis of gingival recession prevalence on the lateralized sides of the maxillary dental arch revealed a clear correlation between the gingival margin status and the occlusal plane tilt angle. At lower tilt angles, gingival recession corresponded to Miller Class I and was primarily observed on the high side (Supra Latus) of the tilt, particularly in the canine and premolar regions. As the tilt angle increased, Miller Classes II and III were more frequently noted, with recession predominantly occurring in the canine and premolar regions on the low side (Infra Latus). No cases of Miller Class IV gingival recession were observed among the participants.

Conclusion. The severity of gingival recession was directly correlated with the occlusal plane tilt angle: a greater tilt angle was associated with more severe recession, as classified by the Miller system. The findings indicate that gingival recession is more prevalent in the canine and premolar regions on the Supra Latus side compared to the Infra Latus side and occurs more frequently in these regions than in other tooth groups.

Relevance. Dental implant treatment is associated with specific risks and complications that may occur either before the completion of osseointegration or around an osseointegrated implant during functional loading, ultimately leading to implant loss. Implant survival is a key criterion for evaluating the clinical efficacy and safety of an implant system.

Objective. To evaluate the one-year survival rate of dental implants from the domestic A2 implant system after placement and to identify the main causes of early implant failure.

Materials and methods. The study was based on the medical records of patients treated with the A2 implant system between November 2022 and October 2023 in three dental clinics. A total of 385 patients were included, and 770 implants were placed. Outcomes were monitored for one year following implant placement. Treatment results were assessed using the following criteria: favorable outcome—implant used as a support for a prosthetic restoration; unfavorable outcome—implant failure.

Results. During the first year, osseointegration was achieved in 765 out of 770 placed A2 implants, followed by successful prosthetic restoration. Five implants failed. Two were removed within the first month due to inflammation at the implant site. One implant became mobile following a domestic injury. Two additional implants were removed prior to definitive prosthetic restoration due to mobility detected during healing abutment placement. Thus, the study identified a 0.6% complication rate in the first year following implantation. The overall early survival rate of the implants was 99.4%.

Conclusion. The evaluated implant design demonstrated clinical effectiveness across various treatment scenarios. The one-year implant survival rate was 99.4%.

Relevance. Despite advances in the reconstruction of extensive jaw defects using vascularized autografts, the issue of multi-stage treatment for such patients remains clinically significant.

Objective. To enhance treatment outcomes in patients with extensive jaw defects and deformities by performing simultaneous dental implant placement during reconstruction with vascularized autografts, thereby shortening the overall treatment and rehabilitation period.

Clinical case description. Using the proposed approach, five patients aged 19 to 44 years were treated for extensive jaw defects – one affecting the maxilla and four involving the mandible. All patients underwent multislice computed tomography (MSCT) of the skull before and after surgery to assess treatment outcomes. During the preoperative planning stage, virtual surgical simulation was performed, and patient-specific cutting guides were fabricated for jaw resection, osteotomy of the vascularized fibular autograft, and dental implant placement. Postoperative assessments, conducted in accordance with the research protocol, confirmed the effectiveness of simultaneous dental implant placement during jaw reconstruction with vascularized autografts. Current data indicate that this method improves treatment efficiency and significantly reduces the rehabilitation period in patients with extensive jaw defects.

Conclusion. The proposed approach – jaw reconstruction using vascularized autografts in combination with simultaneous dental implant placement – proves to be effective. It supports both functional and aesthetic rehabilitation while considerably shortening the recovery period for patients with extensive jaw defects.

Relevance. The diagnostic value of conventional sialography is limited by its technical constraints. Digital sialography overcomes these limitations, allowing the resulting data to be considered more reliable and evidence-based.

Objective: To develop practical recommendations for improving the conventional sialography technique based on data obtained from digital subtraction sialography.

Material and methods. A total of 60 patients with salivary gland disorders underwent digital subtraction sialography, which was used to examine 59 parotid glands and 36 submandibular glands. Patient sex, age, diagnosis, and extent of gland involvement were intentionally not considered in the analysis. The study evaluated: 1) Presence or absence of sensations during contrast agent administration; 2) Volume of contrast agent required for complete ductal filling; 3) Rate of contrast loss from the image after catheter removal. Statistical significance of differences was assessed using Student's t-test, with significance set at p ≤ 0.05.

Results. Optimal ductal filling was accompanied by a sensation of pressure and mild pain in only 5.1% of cases during parotid gland sialography and 2.9% of cases during submandibular gland sialography. No sensations were reported in 79.7% of parotid gland cases (t = 12.49175; p < 0.001) and 82.9% of submandibular gland cases (t = 8.976; p < 0.001). The average volume of contrast agent required to fill the parotid ducts was 1.4 ± 0.3 ml, while for the submandibular ducts (n = 35), it was 1.2 ± 0.3 ml (t = 3.1247; p < 0.001).Within approximately 3 minutes after catheter removal, rapid contrast loss occurred in 86.4% of parotid gland sialograms (t = 11.56244; p < 0.001) and in 88.9% of submandibular gland sialograms (t = 10.50; p < 0.001).

Conclusion. Practical parameters established through digital subtraction sialography can be used when examining salivary glands with an initially unclear structural condition. For parotid sialography, the recommended contrast volume is 1.4 ± 0.3 ml, while for submandibular sialography, it is 1.2 ± 0.3 ml. Injecting contrast until the patient experiences a sensation of pressure or pain may result in overfilling (hypercontrast imaging). In conventional sialography, radiographic imaging should be performed immediately after contrast administration, which requires the patient to remain in the radiology suite during the procedure.

Relevance. This study aimed to evaluate the effectiveness of hemostasis using laser radiation with a wavelength of 445 nm in the donor site of the hard palate. Chronometric analysis was performed to determine the time required to achieve hemostasis in the wound. Additionally, traditional methods of bleeding control commonly used in surgical dental practice during free gingival graft transplantation from the palate were analyzed.

Materials and methods. A study was conducted involving 48 patients with an average age of 39.00 ± 8.43 years who were treated with gingivoplasty and vestibuloplasty with a free gingival graft from the palate. In 75% of cases (n = 36), a free de-epithelialized gingival graft was obtained from the hard palate, while in 25% of cases (n = 12), a free full-thickness mucosal graft was used. Hemostasis in the hard palate donor site was achieved using laser radiation with a wavelength of 445 nm. The procedure was performed in a non-contact, dynamic manner with a non-initiated fiber at 1 W power in continuous mode.

Results. The mean donor site wound area was 248.65 ± 8.78 mm², and the mean time to achieve complete hemostasis was 167.65 ± 7.37 seconds. Regression analysis of coagulation time identified defect size and the presence of epithelium on the graft as significant factors. In cases where a free de-epithelialized connective tissue graft was used, the mean coagulation time increased by 6.8 seconds (p = 0.0005), as determined through contrast assessment in the regression model. No instances of postoperative bleeding at the donor site were observed over the long term.

Conclusion. Laser-assisted hemostasis using 445 nm wavelength radiation offers distinct advantages over conventional hemostatic methods for controlling bleeding at the donor site of the hard palate. Its application reduces the risk of postoperative complications, making it a valuable technique in periodontal and oral surgical practice.

Relevance. Cicatricial pemphigoid (Lortat-Jacob disease, ICD-10 code L12.1) is a rare chronic autoimmune disorder characterized by the formation of subepithelial blisters and erosions on mucous membranes, typically leading to scarring. Since the oral mucosa may serve as the initial site of manifestation, the dentist plays a critical role in the early identification and comprehensive management of this condition

Clinical case description. This article presents two clinical cases of cicatricial pemphigoid (Lortat-Jacob disease). In the male patient, lesions were localized on the oral mucosa and manifested as erosions on the gingiva, soft palate, and vestibular fold. In the female patient, erosions were observed on the soft and hard palate and the alveolar ridge. Due to ocular involvement, both patients required care not only from a dermatologist but also from an ophthalmologist.

Conclusion. Limited awareness of this condition, the variability of its clinical manifestations, and the potential for severe complications highlight the need for interdisciplinary collaboration to ensure early recognition and timely treatment.

Relevance. Drug-induced gingival overgrowth (DIGO) is a recognized adverse effect of various medications, often leading to significant impairments in dental aesthetics, phonetics, mastication, and oral hygiene.

Clinical case description. This report describes a clinical case of drug-induced gingival overgrowth (DIGO) associated with calcium channel blocker therapy. Initial non-surgical periodontal therapy, consultation with the patient’s physician, and diode laser-assisted gingival contouring, along with strong patient adherence, led to stable clinical outcomes over a one-year follow-up period with minimal risk of recurrence.

Conclusion. This clinical case demonstrates the efficacy of diode laser treatment in managing similar conditions and emphasizes the importance of an interdisciplinary approach in the comprehensive care of patients with druginduced gingival overgrowth.