Review

Dec 11

Minimally invasive procedures using injectable hyaluronic acid gel (HA) for the reconstruction of deficient interdental papillae – a systematic review of the literature.

Lisa Cristiana Nemeș 1, Alexandru Vlasa 1
1 George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, Romania

Introduction: The gingival papilla, also known as the interdental papilla, is the triangular portion of gum tissue that occupies the space between two neighboring teeth. In the anterior region, papillae typically appear more pyramidal, while in the posterior they tend to be more blunted. Its shape and height are determined by factors such as the position of the contact points and the underlying bone structure. When the papilla is absent, it creates a “dark triangle”, which can lead to esthetic issues, increased root sensitivity, and a greater risk of plaque accumulation.

Aim of the study: The purpose of the study involves highlighting the minimum invasive reconstruction techniques using the hyaluronic acid for papilla regeneration.

Material and Methods: This article aimed to provide a comprehensive review of the recent techniques used in minimally invasive procedures for papilla regeneration. Relevant literature was identified through a search of electronic databases, including PubMed, ResearchGate, and Google Scholar using the following keywords: “interdental papilla regeneration”, “hyaluronic acid”, “minimally invasive treatment”.

Results: The initial literature search yielded 114 articles. Later a step-by-step selection process was carried out based on clear inclusion criteria. Free-full text versions of the selected articles were then reviewed in detail to ensure they met the inclusion criteria. Based on the analysis performed, 11 articles extracted from literature were used in the present study.

Conclusions: Within the constraints of this study, the application of a commercially available hyaluronic acid (HA) gel for treating interdental papillary deficiency appears to be both effective and promising. However, the current body of evidence is still limited, with few high-quality clinical trials conducted on this technique. Future studies should address larger sample sizes, optimal HA concentrations, and standardized injection protocols to better assess its long-term efficacy and safety.

DOI: https://doi.org/10.62838/ASMJ.2025.2.04

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This entry was posted in Review, Volume 8, Issue 2, December 2025 on December 11, 2025
Dec 11

Periodontal Disease and Celiac Disease – A systematic review regarding the Clinical Significance.

Hermina Reka Marton 1, Alexandru Vlasa 1
1 George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, Romania

Introduction. Celiac disease is an autoimmune condition caused by the reaction of the body to gluten in people who are genetically sensitive. Periodontal disease is a chronic inflammation of the gums and tissues that support the teeth, caused by harmful bacteria and an overactive immune response. Recent research has showed that these two diseases are connected and a complex interplay exists.

Aim of the study. The present paper aims to explore and synthesize the scientific evidence concerning the complex interrelationship between celiac disease and periodontal disease.

Methods. This review synthesizes data of studies published between 2020 and 2025 concerning the clinical, immunological, and microbiological associations between celiac disease and periodontal disease. Articles were identified through PubMed and Scopus searches using the terms ‘celiac disease’, ‘periodontal disease’, and ‘oral manifestations of celiac disease’.
Results. Based on the analysis of 14 articles extracted from the literature, the findings clearly demonstrate that celiac disease and periodontal disease are interconnected through complex immunological, nutritional, and microbial pathways, supporting the concept of a gut-oral inflammatory axis.

Conclusions. The coexistence of celiac disease and periodontal disease illustrates the systemic nature of mucosal inflammation. Interdisciplinary cooperation among dentists, gastroenterologists, and nutritionists is essential for early recognition, prevention, and integrative treatment.

DOI: https://doi.org/10.62838/ASMJ.2025.2.05

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This entry was posted in Review, Volume 8, Issue 2, December 2025 on December 11, 2025
Dec 11

The Role and Clinical Applications of Bioceramic Materials in Modern Endodontic Practice: A Review of the Literature.

Yunus Emre Çakmak 1, Kürşat Er 1
1 Department of Endodontics, Faculty of Dentistry, Akdeniz University, Antalya, Türkiye

Bioceramic materials represent a significant paradigm shift in endodontics over the past three decades. This revolution, initiated by the development of mineral trioxide aggregate (MTA) in 1993, is attributed to the superior properties of these materials, such as excellent biocompatibility, bioactivity, sealing ability, and high alkalinity (pH ~12.5). This review summarizes the historical development, classification, physical, chemical, and biological properties, and current clinical applications of bioceramics. In clinical applications, calcium silicate-based materials such as MTA and Biodentine demonstrate success rates exceeding 90% in vital pulp therapy (pulp capping and pulpotomy) by promoting the formation of a dentin bridge. As root canal sealers, they have popularized the single-cone technique, achieving 90-99% clinical success rates by chemically bonding to dentin and providing a long-term seal. Furthermore, they have become the gold standard for apexification, perforation repair, management of resorption defects, and as a retrograde filling material in apical surgery. In regenerative endodontic procedures, they enhance long-term tooth survival by supporting continued root development. Nevertheless, certain limitations remain, including prolonged setting times, handling difficulties, the potential for tooth discoloration, and challenges associated with retreatment procedures. Despite these limitations, bioceramics have become an indispensable component of modern endodontics when applied with proper indications and techniques, significantly improving treatment outcomes and offering patients more biologically-oriented and conservative treatment options.

DOI: https://doi.org/10.62838/ASMJ.2025.2.02

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This entry was posted in Review, Volume 8, Issue 2, December 2025 on December 11, 2025
Jun 16

Data about application of chlorhexidine as a periodontal irrigant – Systematic Review

Ilma Robo 1, Manola Kelmendi 1, Eva Habazaj 1, Kristi Sulanjaku 2, Nevila Alliu 1
1 University of Medicine, Tiranë, Albania
2 Albanian University, Tiranë, Albania

Introduction. The most commonly used lavage solution for periodontal irrigation are diluted antiseptic solutions, the most important of them, is chlorhexidine solution. The ability of chlorhexidine to be fixed for periods of time of 8 hours on the surface of the tooth is among the main characteristics of the mechanism of action of this solution. Aim of the study. The aim of this study is to reveal the latest news about the indications for the application of chlorhexidine in cases of periodontal pathologies. Material and Methods. The electronic search to complete the purpose of the study was carried out on PubMed website for the last 3-year period, using the selected key words. Results. Based on the analysis of 32 articles extracted from the literature, from the combination of the key words chlorhexidine and endodontics and periodontics, not antibiotics, not probiotics, it was noticed that only 1 article was not included in the scope of our study. Conclusions. For chlorhexidine as a periodontal solution, the effects are known mainly in the control of bacterial plaque, but it is believed that new ways or different systems of its release should be found to express the periodontal effect. The side effects of chlorhexidine as a periodontal irrigating solution are better known, but in the processed data no concrete conclusions emerge as to which concentration of chlorhexidine would be the most indicated for specific periodontal diagnoses.

DOI: https://doi.org/10.62838/ASMJ.2025.1.02

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This entry was posted in Review, Volume 8, Issue 1, June 2025 on June 16, 2025
Dec 12

Causes and prevention of endodontic file fractures: a review of the literature.

Damla Erkal 1, Kürşat Er 1
1 Akdeniz University, Antalya, Turkiye

Endodontic file fracture has traditionally been viewed as an undesirable event. However, recent evidence suggests that the incidence of fracture may be higher with rotary nickel-titanium (NiTi) files. Therefore, it is crucial for clinicians to be aware of the prevalence of file fracture and the underlying causes of this unfortunate occurrence. The removal of fractured files is technically challenging and time-consuming, making it essential to implement measures to prevent fracture whenever possible. Over the past decade, file manufacturers have introduced various modifications such as mechanical and heat processes to NiTi alloys to reduce the likelihood of file separation, though with varying degrees of success. The aim of this review is to explore the prevalence and causes of file fracture, and to assess the efficacy of the recommended prevention protocols. Furthermore, the review evaluates the effectiveness of alloy modifications in reducing the incidence of file fracture. The analysis reveals that much of the literature on file fracture is based on in vitro studies, which limits its clinical relevance. The reported incidence of NiTi file fracture is similar to that of stainless steel (SS) files; however, inconsistent methodologies make accurate comparison difficult. NiTi files are reported to fail primarily due to torsional overload and/or flexural fatigue, with fractures occurring most often in the apical third of the canal or due to improper use. Finally, factors such as operator skill, manufacturer modifications, and limiting file reuse have been shown to significantly reduce the incidence of fracture, highlighting the importance of a robust prevention strategy.

DOI: https://doi.org/10.62838/ASMJ.2024.2.05

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This entry was posted in Review, Volume 7, Issue 2, December 2024 on December 12, 2024
Jan 09

Systematic Review Regarding The Difference In Dental Plaque Accumulation Associated With Fixed Orthodontic Retainers And Vacuum Formed Removable Retainer

Enrica Muggianu 1, Damiano Musilli 1, Antonella D’Andrea 1
1 George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, Romania

Introduction: Orthodontic retention is fundamental to prevent tooth relapse after the treatment. Plaque accumulation is a serious concern, affecting periodontal health. In this study, the effects of fixed retainers with removable vacuum formed retainers on plaque accumulation by evaluating the Plaque Indices were compared.
Aim of the study: The aim of the present systematic review is to comprehend which orthodontic retainer between fixed retainers and the removable vacuum formed retainers results in the least amount of plaque accumulation.
Material and Methods: For evaluation a literature review was carried out by all the reviewers by consulting PubMed, ScienceDirect, The Lancet, Sciendo, and Google Scholars electronic databases for biomedical and health literature. The articles were selected from 2017 onwards with the restriction of the English language.
Results: 5 studies were selected, reporting on a total of 249 patients both males and females who after debonding orthodontic appliances followed up with either a fixed or vacuum formed retainer.
Conclusion: Within their limits, the results seem to show that patients who wear Vacuum Formed Retainers tend to accumulate less plaque than the ones that wear Fixed Retainers. However, subsequent studies are required to address this matter and draw a definitive conclusion.

DOI: https://doi.org/10.2478/asmj-2023-0008

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This entry was posted in Review, Volume 6, Issue 2, December 2023 on January 9, 2024
Jun 29

The Link Between Noncarious Cervical Lesions (NCCL) And Gingival Recession. Etiology And Treatment. A Narrative Review

Luminița Lazăr 1, Zsigmond-Loránd Makkai 1, Timea Dakó 1, Mircea Suciu 1, Ana-Petra Lazăr 1
1 George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, Romania

Noncarious cervical lesions (NCCL) have a multifactorial etiology. The terms abfraction, abrasion, and erosion are also used to describe the same lesion. NCCLs can lead to gum recession which is one of the most frequent gingival defects. NCCLs generally also involve loss of tooth structure. Therefore, treatments should be planned and performed in an interdisciplinary manner. When NCCL is minimal, the choise to use simple direct restorations is the main therapeutic option. If it is serious, microsurgical treatment or, more precisely, interdisciplinary treatment might be necessary. Root coverage by microsurgical methods is the most challenging esthetic procedure. There are many techniques available of which we must always choose the method that can ensure and control root coverage in the long term.

DOI:  https://doi.org/10.2478/asmj-2023-0002

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This entry was posted in Review, Volume 6 Issue 1, June 2023 on June 29, 2023
Dec 20

Clinical outcomes of predoctoral implant dentistry education: A Systematic Review

Disha Nagpal 1, Carlos Flores-Mir 1, Usama Nassar 1, Liran Levin 1
1 University of Alberta, Canada

Objectives: To systematically synthesize the status of predoctoral implant dental education in terms of clinical outcomes including implant success and survival of them when placed by predoctoral students.
Materials and methods: A thorough search was carried out up to February 2019 using Medline (OVID), EMBASE, ERIC, and Web of Science electronic databases. In addition to this, bibliographies of the potentially eligible articles were searched manually. Abstracts that seemed to satisfy the initial selection criteria were selected for the recovery of the full text. The full-text risk of bias assessment was then done, in line with the selection criteria by two reviewers. The selected articles were evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal tools. The GRADE approach was adapted, but not validated, for observational studies to assess the certainty of evidence.
Results: Overall, 15 articles were included. Most of the reported implants were used to support mandibular overdentures or single unit implants and their survival rates were found to be generally favorable. Only a few studies also used patient satisfaction surveys which displayed overall satisfaction, suggesting that the dental implant treatment may be adequately provided in school settings.
Clinical significance: The success and survival of the implant’s type done in an undergraduate classroom setting is indicative of the undergraduate dental implant curriculum. Based on this work, it can be concluded that the success and survival of such implants appear to be reasonable and most of the patients getting an implant at the school were satisfied.

DOI: https://doi.org/10.2478/asmj-2022-0009

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This entry was posted in Review, Volume 5 Issue 2 , December 2022 on December 20, 2022
Dec 20

Current status of predoctoral implant dentistry education – student’s didactic performance and self-assessment: A Systematic Review

Disha Nagpal 1, Carlos Flores-Mir 1, Usama Nassar 1, Liran Levin 1
1 University of Alberta, Canada

Objectives: To describe the current state of predoctoral dental implant education in terms of educational outcomes and the student’s perception of the associated curriculum. Methods: A database search was conducted using Medline (OVID), EMBASE, ERIC (Education Resources and Information Centre) and Web of Science electronic sources. Two reviewers thoroughly reviewed the papers in accordance with the specific selection criteria after carefully choosing the abstracts that seemed to meet the initial selection criterion for full article retrieval. Results: 15 articles were included, which were divided into two distinct groups: those that addressed educational outcomes and those that addressed students’ perceptions. Knowledge was assessed by questionnaire surveys, and it was found that most of the students were poorly to moderately well informed. There was a positive increase in student perception after taking the implant courses. Clinical significance: Although predoctoral education in most dental schools across the world now includes implant dentistry as a core component, the degree of integration varies greatly. To increase the proficiency of predoctoral students around the world in performing implant treatments, it is necessary, according to this systematic review, to create a uniform, well-structured predoctoral implant curriculum and guidelines that include didactic, laboratory, preclinical, and clinical components.

DOI: https://doi.org/10.2478/asmj-2022-0008

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This entry was posted in Review, Volume 5 Issue 2 , December 2022 on December 20, 2022
Jun 21

The influence of smoking on the periodontal biome. A review.

Luminița Lazăr 1, Timea Dakó 1, Andreea Cozma 2, Ana-Petra Lazăr 1
1 George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu-Mureș, Romania
2 County Emergency Clinical Hospital Târgu Mureș, Romania

Periodontal disease is believed to be an opportunistic infection due to the interaction of bacterial plaque and the patient’s response that may be influenced by environmental, genetic, and other risk factors. In addition to the fact that smoking is considered a risk factor in many systemic diseases, it has also been associated with the initiation of periodontal disease. Smoking is one of the modifiable risk factors and has a significant influence on the development, progress, and results of the treatment of periodontal disease. The current state in the field of study suggests that smoking aids the colonization of periodontal microorganisms, accelerating the onset of periodontal disease. Biological modifications in pathogens, such as Porphyromonas gingivalis, along with poor immune response, influence the variations of subgingival flora in smoking patients. Only with an individual approach can the risk factors of each patient be identified and satisfactory results obtained. The aim of this paper is to present a comprehensive review of the influence of smoking on periodontal microbiome and the importance of adopting the appropriate treatment method according to the influence of this risk factor on healing.

DOI: https://doi.org/10.2478/asmj-2022-0002

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This entry was posted in Review, Volume 5 Issue 1, June 2022 on June 21, 2022