Soft Tissue Inflammation Research Articles

Imaging in clinical trials for psoriatic arthritis: a scoping review.

Psoriatic arthritis (PsA) is a chronic inflammatory condition principally affecting the skin and musculoskeletal system, associated with comorbidities and decreased quality of life. Imaging is crucial for diagnosis, monitoring progression, and evaluating treatment efficacy; therefore, it plays an important role in PsA clinical trials. In this review, we aimed to characterize how imaging modalities and advances in imaging techniques are being used specifically in the PsA clinical trial literature. Following the Arksey and O'Malley framework for scoping reviews, we conducted a comprehensive search of multiple literature databases, from January 1, 2000, to June 27, 2024. We captured 1961 articles and after deduplication, title and abstract screening, and full-text review, 53 studies were included. Radiographs were the most used imaging modality (n = 32/53, 60%), and radiographic progression was frequently measured using the PsA-modified Sharp/van der Heijde score. MRI (n = 16/53, 30%) was used in evaluating peripheral and axial disease, with more recent adoption of validated scoring systems (PsAMRIS and SPARCC). Ultrasound (n = 11/53, 21%), including power Doppler, was used to assess soft tissue inflammation. Standardized scoring systems (e.g. GLOESS) were used in a minority of ultrasound-based studies. Multimodality imaging (n = 7/53, 13%) and CT (n = 2/53, 4%) was uncommon. The development of PsA-specific scoring systems for radiographs and MRI has been instrumental in advancing imaging assessment in PsA. However, their application remains limited, particularly in ultrasound, where further standardization is needed. Future clinical trials should focus on increasing the adoption of PsA-specific scoring systems, exploring advanced techniques (e.g. DCE-MRI), and multi-modal imaging to improve PsA disease monitoring.

Role of antimicrobial photodynamic therapy for the management of peri‑implant diseases among habitual nicotinic product users: A systematic review.

The objective was to systematically review original studies that assessed the influence of antimicrobial photodynamic therapy (aPDT) for managing peri‑implant diseases among habitual nicotinic product (NP) users. The research question was "Is aPDT effective for managing peri‑implant diseases among NP users?" Indexed databases (PubMed/Medline, EMBASE, Scopus, and ISI Web of Knowledge) and Google Scholar were searched up to and including December 2024 without time and language barriers. Using Boolean operators, the following keywords were searched in different combinations: antimicrobial photodynamic therapy; crestal bone loss; peri‑implant diseases; probing depth; nicotine; and smoking. Original clinical studies were included. Letters to the Editor, Case-reports, case-series, commentaries, reviews and perspectives/expert opinions were excluded. The literature search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses. The risk of bias (RoB) was assessed using the Cochrane RoB 2 tool. Seven RCTs performed on adult males were included and processed for data extraction. The mean ages of participants ranged between 31 and 57 years. The wavelength of the diode laser ranged between 660 and 670 nm in all studies. Results from all RCTs showed that aPDT, when performed as an adjunct to MD, is more effective in reducing peri‑implant plaque index, bleeding scores, and peri‑implant PD in contrast to when mechanical debridement (MD) was performed alone. None of the studies reported a statistically significant difference in crestal bone height, irrespective of whether MD was done with or without adjunct aPDT. In all studies, the follow-up duration ranged between 3 and 12 months. The aPDT was performed once (after MD) in all studies. All studies had a low RoB and their results were based on power-adjusted data. In the short term, a single session of aPDT as an adjunct to MD effectively reduces peri‑implant soft-tissue inflammation among NP users with peri‑implant diseases. However, this treatment does not influence CBL in these patients.

Free gingival graft for augmenting peri-implant keratinized mucosa

Insufficient keratinized mucosa is a common clinical problem. Although there is no consistent data on the long-term success of implant restorations relative to the presence or absence of peri-implant keratinized mucosa, it is widely accepted that the presence of keratinized mucosa width<2 mm is associated with increased biofilm accumulation, soft-tissue inflammation, and mucosal recession. Free gingival graft (FGG) is the standard surgical intervention for augmenting the width of keratinized gingiva. However, the clinical application of FGG is technique-sensitive. Therefore, this article describes the significance and efficacy, surgical timing, conventional procedures and techniques, common complications, as well as some modified approaches of the FGG, aiming to provide guidelines for its clinical application.

Review on Pharmacological Evaluation of Anti-Inflammatory Agents

Anti - inflammatory diseases and pain are among the main problems that significantly influence the lifestyle of millions of people and existing therapies are not always effective and can cause several adverse effects. In this context, the molecular modifications or synthesis of compounds continue being the best strategies for the identification of new compounds for the treatment of pain and inflammation. The aim of this study was to evaluate the anti-inflammatory activities The clinical phase further validated the drug's efficacy in reducing symptoms of inflammatory disorders, including arthritis and soft tissue injuries. Its tolerability and multi-target action position it as a promising alternative to existing therapies. This evaluation supports the potential of the drug for clinical use, offering a new avenue for managing inflammation with reduced side effects. Future studies will focus on long-term safety and broader therapeutic applications.Safety assessments indicated minimal adverse effects at therapeutic doses, with a superior gastrointestinal and cardiovascular safety profile compared to traditional NSAIDs.Compare the efficacy and safety of the agent with standard anti-inflammatory drugs (e.g., NSAIDs, corticosteroids, or biologics). Test the drug in models of acute and chronic inflammation to assess its versatility. Investigate its therapeutic efficacy in specific inflammatory conditions, such as arthritis, colitis, or other autoimmune disorders.Anti-inflammatory drugs, including non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids, are widely used for managing pain, inflammation, and chronic conditions such as arthritis. While effective, their use is associated with significant adverse effects, such as gastrointestinal, cardiovascular, renal, and hepatic toxicities, as well as allergic reactions. Pharmacovigilance, the science and activities involved in detecting, assessing, understanding, and preventing adverse drug reactions (ADRs), plays a critical role in ensuring the safe use of these medications

An Atypical Case of Orbital Wall Infarction Secondary to Sickle Cell Disease in an Adult and Review of Literature.

Sickle cell disease is known to cause painful vaso-occlusive crises in long bones with large marrows. Orbital infarction is a rare complication of sickle cell disease and usually presents in children and adolescents with acute onset periocular swelling mimicking orbital cellulitis. We describe an atypical case of a 38-year-old man with homozygous sickle cell disease who presented with isolated, complete ptosis of his OD with minimal swelling. He described brow aches on the same side, with no features of proptosis, ophthalmoplegia, or compressive optic neuropathy. Orbital imaging revealed infarction in the right frontal bone and orbital roof, with inflammatory soft tissue swelling. His condition resolved completely after 4 days with conservative medical therapy alone.

ASSESSMENT AND TREATMENT STRATEGIES FOR PERI-IMPLANT MUCOSITIS AND PERI-IMPLANTITIS

Background: Peri-implant mucositis and peri-implantitis are common inflammatory conditions affecting the tissues surrounding dental implants. Peri-implant mucositis involves inflammation confined to the soft tissues, while peri-implantitis leads to both soft tissue inflammation and progressive bone loss. The increasing prevalence of these conditions presents significant challenges in restorative dentistry, necessitating effective management strategies to preserve implant health and longevity. Early diagnosis and tailored treatment plans are critical to mitigating disease progression and maintaining optimal clinical outcomes. Objective: This study aimed to evaluate the efficacy of various non-surgical and surgical treatments for peri-implant mucositis and peri-implantitis, focusing on clinical outcomes such as probing depth (PD) and bleeding on probing (BoP). Additionally, the study sought to provide evidence-based recommendations for optimal dental practices. Methods: The study reviewed data from recent clinical trials and comparative studies examining the outcomes of mechanical debridement, adjunctive antimicrobial therapies, and surgical interventions such as implantoplasty and guided bone regeneration (GBR). Treatment effectiveness was assessed based on reductions in PD and BoP over follow-up periods ranging from 3 to 12 months. Success rates and recurrence rates were also analyzed to determine the long-term stability of different approaches. Results: Non-surgical treatments achieved significant improvements, with mechanical debridement combined with chlorhexidine reducing PD from 4.0 mm to 2.8 mm and decreasing BoP by 57% within 6 months. Diode laser therapy showed smaller PD reductions (3.6 mm to 3.0 mm) but a 62% BoP improvement over 3 months. Surgical interventions demonstrated superior outcomes, with implantoplasty and GBR reducing PD by 2.5 mm (5.5 mm to 3.0 mm) and decreasing BoP by 75% (80% to 20%) over 12 months. Recurrence rates were lower for surgical treatments (10% over 2 years) compared to non-surgical methods (25-35% within 1-2 years). Conclusion: Individualized treatment plans are essential for managing peri-implant conditions effectively. Non-surgical therapies are effective for early-stage disease, while surgical interventions are necessary for advanced cases. Long-term success depends on integrating these approaches with regular follow-up care and patient education. A comprehensive, evidence-based strategy is critical for optimizing patient outcomes and ensuring implant longevity.

Histopathological diagnostics of infections in rheumatology

The histopathological differential diagnoses of inflammatory infectious and inflammatory noninfectious diseases of the musculoskeletal system, particularly infectious and noninfectious arthritis, soft tissue inflammation and osteomyelitis in rheumatology are presented with afocus on the differential diagnostic possibilities and limitations; however, adiverse spectrum of pathogenic mechanisms underly these diseases, which can present with similar inflammatory response patterns. This wide spectrum of inflammatory pathogenesis of infectious and noninfectious diseases includes diseases such as rheumatoid arthritis, gouty arthritis, osteomyelitis and pyoderma gangrenosum, which cannot clinically be manifested thus necessitating a histopathological clarification. In terms of tissue sampling the following general principle applies: the larger the tissue sample and the more diverse the sites of tissue extraction, the more conclusive are the histopathological diagnostics. This diagnostic approach to infections, especially in arheumatological context, is generally considered complementary and even supplementary to microbiological diagnostics. Furthermore, consideration of the virulence-resistance relationship, which can alter the inflammatory pattern, is of additional relevance. Consequently, definitive causal diagnostics are only achievable within the clinical, rheumatological, microbiological, laboratory medical and infectiological context.

Focusing on ligamentous soft tissue inflammation for the future understanding of early axial psoriatic arthritis

Abstract Imaging has transformed the understanding of inflammatory and degenerative arthritis in both peripheral and axial disease. In axial inflammation, fat suppression magnetic resonance imaging (MRI) has unravelled the role of sub-fibrocartilaginous osteitis in axial spondyloarthritis and the role of peri-entheseal vertebral body osteitis and subsequent spinal new bone formation. Established or late-stage axial psoriatic arthritis (PsA) cases often exhibit impressive para-marginal or chunky syndesmophytosis on conventional X-ray that pathologically represents entheseal soft tissue ossification. However, the spinal entheseal soft tissue and contiguous ligamentous tissues are poorly visualized on MRI in subjects with early inflammatory back pain including those with axial PsA. In this article, we highlight the need for imaging modalities to discern the crucial soft tissue “ligamentous” component of axial PsA towards diagnosis, prognosis and therapy validation. We issue a clarion call to focus advanced imaging methodology on spinal ligamentous soft tissue that represents the last hidden backwater of PsA immunopathology that needs visualization to fully decipher axial PsA pathogenesis. This in combination with the existing ability to visualize ligamentous bony anchorage site osteitis is needed to define a gold standard test for axial PsA.

Indicators of oxidative stress and tissue hypoxia in various phases of Graves’ orbitopathy activity

Graves’ orbitopathy (GO) is an extrathyroid complication of thyroid dysfunction characterized by chronic autoimmune inflammation of soft retrobulbar tissues. The data on the role of oxidative and hypoxic stress in GO are heterogeneous, which necessitates further research.The aim of the study. To evaluate the indicators of oxidative stress and tissue hypoxia at various phases of Graves’ orbitopathy activity.Material and methods. Examination of patients with GO (n = 32), with autoimmune thyroid pathology (n = 18) and healthy individuals (n = 15) was performed. The study included ophthalmological examination and blood sampling to determine the concentration of antibodies to the thyroid-stimulating hormone receptor, interleukin 17A (IL-17A), hypoxia inducible factor 1a (HIF-1a), TBK-active products and calculation of total antioxidant activity.Results. An increase in the concentration of TBK-active products in the clinical group was revealed compared with the control (p &lt; 0.001). The total antioxidant activity was reduced at all phases of GO activity than in the control (p &lt; 0.001). The level of HIF-1α did not differ in the study groups (H = 3.29; p = 0.51). Direct moderate correlations were found between the concentration of IL-17A and the level of TBA-active substances (p = 0.001), as well as inverse moderate correlations with the value of total antioxidant activity (p = 0.007). The activity of GO had weak correlations with total antioxidant activity (p &lt; 0.001). Significant correlations between indicators of oxidative stress and tissue hypoxia were not found.Conclusion. In GO, regardless of the activity phase, there is an imbalance between the parameters of the “lipid peroxidation – antioxidant protection” system, which is manifested by an increase in TBA-active substances while reducing the total antioxidant activity. The indicators of tissue hypoxia did not differ in the study groups. The revealed correlations between the autoimmune inflammation activity in the orbit and oxidative stress emphasize the pathogenetic conditionality of the antioxidant drugs appointment in the therapy of GO.

Neuroborreliosis

Background Neuroborreliosis is involvement of the nervous system in Lyme disease and can often be overlooked as a diagnosis in patients presenting with cranial neuropathies and meningitis in an endemic area. There can be variability in presentation with respect to the involved cranial nerves, making the diagnosis challenging. To the best of our knowledge, there have been no reported cases of Lyme disease cranial neuropathy occurring with simultaneous periorbital skin and soft tissue inflammation in the literature. Case We present the case of a healthy 25-year-old man who presented to the emergency department with headache, diplopia, and left eye pain after experiencing fever, malaise, and a recent history of unilateral facial palsy that improved a few weeks prior. He lived in a Lyme disease endemic area and often encountered ticks. He was found to have an abduction deficit in his left eye, preseptal and postseptal orbital inflammation with bilateral optic perineuritis, and a lymphocytic pleocytosis in the cerebrospinal fluid accompanied by an elevated antibody index, consistent with a diagnosis of Lyme neuroborreliosis. He was treated with doxycycline and empiric bacterial coverage, with symptom resolution at follow-up. Conclusion This case represents an unusual combination of cranial neuropathies and is the first report of orbital inflammation driven by Lyme neuroborreliosis, thought to be caused by contiguous spread of inflammation from affected portions of the nervous system. Although neuroborreliosis is less commonly encountered in the United States than in Europe, providers should maintain a high index of suspicion for this entity when patients present with multiple cranial neuropathies in an endemic area and not exclude Lyme disease on the basis of skin and soft tissue inflammation.

Diabetes mellitus exacerbates inflammation in a murine model of ligature-induced peri-implantitis: A histological and microtomographic study.

To investigate the influence of diabetes mellitus (DM) in a murine model of peri-implantitis (PI). Twenty-seven 4-week-old C57BL/6J male mice had their first and second maxillary left molars extracted. Eight weeks later, one machined implant was placed in each mouse. Four weeks after osseointegration, the mice were divided into three groups: (a) control (C), (b) PI and (c) DM + PI. DM was induced by streptozotocin (STZ) administration. After DM induction, PI was induced using ligatures for 2 weeks. The hemimaxillae were collected for micro-CT and histological analyses. The primary outcomes consisted of linear (mm) and volumetric (mm3) bone loss. Secondary outcomes were based on histological analysis and included inflammatory infiltrate, osteoclastic activity, matrix organization, composition and remodelling. Data are presented as means ± SEM. Statistical analyses were performed using one-way ANOVA, followed by Tukey's test. Gingival tissue oedema was detected in the PI and DM + PI groups. Micro-CT showed significantly increased linear and volumetric bone loss in the DM + PI group compared to the C and PI groups. H&E staining showed greater inflammatory response and bone resorption in the PI and DM + PI groups than in the C group. The DM + PI group had significantly higher osteoclast numbers than the C and PI groups. Picrosirius red stained less for types I and III collagen in the PI and DM + PI groups than in the C group. There was a significant increase in monocyte/macrophage (CD-11b) counts and matrix metalloproteinases (MMP-2 and MMP-8) marker levels and a significant decrease in the matrix metalloproteinases inhibition marker (TIMP-2) levels in the DM + PI group compared to the C and PI groups. DM exacerbates PI-induced soft-tissue inflammation, matrix degradation and bone loss.

The Role of Neutrophil-to-Lymphocyte Ratio and Mean Platelet Volume in Diagnosing Odontogenic and Non-odontogenic Head and Neck Abscesses.

Introduction Head and neck abscesses are categorized as either odontogenic, originating from dental infections, or non-odontogenic, arising from soft tissue inflammation. This article aimed to investigate inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV), and compare them against established diagnostic parameters such as white blood cell (WBC) count, neutrophil count (Neu), lymphocyte count (Ly), platelet count (PLT), C-reactive protein (CRP), and procalcitonin (PCT). Material and methods Our retrospective analysis of a prospective study involved 80 patients, including 50 individuals (56% men) with an average age of 41.6±18.18 years diagnosed with odontogenic abscesses and 30 patients (66.7% men) with an average age of 44.53±15.49 years diagnosed with non-odontogenic head and neck abscesses, during the period from July 2021 to June 2022. The complete blood count provided data on WBC, Neu, Ly counts, MPV, and PLT using a 5-diff hematological analyzer. The MPV to PLT index (MPI) was calculated by dividing MPV by PLT, neutrophil-to-lymphocyte ratio (NLR) by dividing Neu by Ly, and platelet-to-white blood cell ratio (PWR) by dividing PLT to WBC. A latex-enhanced immunoturbidimetric assay was used to determine CRP (mg/L) on Cobas 6000 and PCT (ng/mL) on Advia 1800. Results PLT, PCT, and Ly were lower in patients with odontogenic abscesses compared to those with non-odontogenic abscesses (p<0.05), while CRP and Neu were significantly elevated in the odontogenic abscess group (p<0.05). In the non-odontogenic abscess group, men presented higher CRPlevels (50.39±64.99 ng/mL versus 9.77±8.36 mg/L), MPI (0.036±0.017 ng/mL versus 0.029±0.01 ng/mL), and NLR (5.6±5.66 versus 3.09±2.2) compared to women (p<0.05). In contrast, women exhibited higher PLT values (390.78±197.129x109/L versus 220.33±55.153x109/L) and PWR (43.88±32.72 versus 23.86±9.34) compared to men (p<0.05). A significant combination of Ly% and Neu% was identified for predicting the MPVvalue in the non-odontogenic abscess group (R²=0.126, p=0.042), NLR and PWR as a predictor of CRP in both study groups (p<0.05) (R²=0.3for the non-odontogenic abscess group, R²=0.448 for the odontogenic abscess group), and NLR and PWR as predictors for PCT values in those with non-odontogenic abscesses (R²=0.239, p=0.025). Discussion Despite the expected association between elevated MPV and heightened inflammatory responses, our findings revealed an inverse correlation between MPV and Neu and Ly in patients with non-odontogenic abscesses. This indicates complex interactions in immune responses during inflammation and underscores the need for further investigation to clarify MPV's role across different abscess types. Integrating traditional inflammatory markers such as CRP and PCT with indices such as NLR and MPV can enhance our understanding of inflammatory responses and improve predictions regarding patient outcomes in head and neck abscesses. Conclusion Our study confirms the value of combining traditional inflammatory markers such as CRP and PCT with indices such as NLR and MPV to assess the severity of infections in head and neck abscesses. These biomarkers provide significant insights into inflammatory responses and may improve patient outcome predictions. However, further research with larger, diverse populations is needed to fully integrate these markers into routine clinical practice for better management of such infections.

Chronic nonbacterial osteomyelitis in neuroradiology – behavior and evolution of vertebral and mandibular lesions on imaging

BackgroundChronic nonbacterial osteomyelitis (CNO) is a rare non-infectious inflammatory musculoskeletal disease where imaging plays a key diagnostic role. Vertebral and mandibular lesions are frequent manifestations, meaning their awareness is crucial for the neuroradiologist to avoid delays in diagnosis and treatment.ObjectiveCharacterize vertebral and mandibular CNO lesions on imaging to assist practicing neuroradiologists in better identifying this disease.Materials and methodsRetrospective review of all CNO patients of our pediatric center, including only patients with vertebral or mandibular lesions. All imaging exams were analyzed to record lesion characteristics.ResultsWe included 13 patients (six male). The mean age of onset was 12.3 years. Ten patients had only vertebral lesions, two had only mandibular lesions, and one had both. For patients with vertebral lesions, the median number of levels affected was three, 81.8% had multiple levels affected, 90.0% had dorsal spine lesions, 72.7% had platyspondyly, and 81.8% had inflammatory changes. All vertebral lesions had at least partial resolution of inflammatory findings, the mean time of lesion activity was 2.5 years, and recurrence occurred in 27.3%. Three patients had sacral lesions, all with sacroiliitis. In patients with mandibular lesions, all had unilateral lesions involving the mandibular ramus, all had hyperostosis, periosteal reaction, bone edema, and soft tissue inflammation, all had partial resolution on follow-up, and one had recurrence.ConclusionCNO vertebral lesions are not rare, are often multiple, predominantly affect dorsal levels, and most result in vertebral height loss. Resolution of vertebral inflammatory lesions is frequent, but so is recurrence. Sacral lesions may be present and result in sacroiliitis. The mandible may be a site of unifocal disease, typically affecting the ramus, with prominent bony changes and soft tissue inflammation.Graphical

Fibrodysplasia ossificans progressiva: a comprehensive review

Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disorder that causes heterotopic ossification of soft tissues, leading to abnormal bone growth in muscles, tendons, and ligaments. First identified in the 17th century, FOP was classified in 1968 and is linked to a mutation in the Activin A receptor type I gene (ACVR1) which affects bone morphogenetic protein (BMP). The autosomal dominant condition FOP has the potential to lead to aberrant bone development. At birth, FOP individuals appear normal, except for characteristic malformations of the great toes. FOP patients develop painful, inflammatory soft tissue swellings during the first decade of life, often precipitated by soft tissue injury. Minor trauma can trigger new flare-ups and leads to progressive heterotopic ossification. Most FOP sufferers are wheelchair-bound by their third decade and needs lifelong assistance with daily living tasks. Bone morphogenetic proteins (BMPs) are bound by the transmembrane kinase receptor ALK2, which is encoded by the (ACVR1/ALK2 gene). FOPs induce heterotopic bone formation in skeletal muscle and can be caused by mutations in the activin A receptor type I (ACVR1) and activin-like kinase 2 (ALK2) gene. Clinical therapy focuses on preventing and controlling inflammation, with ongoing research focusing on specific therapies targeting receptor activity, aberrant pathways, or cellular components influencing bone neo-formation.

Dynamics of perifocal reactions to the application of antimicrobial gel in one-stage hip replacement under conditions of staphylococcal infection in the experiment

Background. Local antibacterial therapy in the treatment of osteomyelitis significantly increases the effectiveness of surgical debridement.The aim of the work. To assess in an in vivo experiment the dynamics of perifocal tissue reactions to the application of an original polyvinylpyrrolidone-based antimicrobial gel in a one-stage treatment of implant-associated infection in the hip joint in rabbits.Methods. Implant-associated infection was modeled by inserting Staphylococcus aureus-infected wires into the medullary canal of the femur of rabbits (n = 12). On the day 14, we removed the wire and performed radical surgical treatment of the suppurative focus and hip replacement. The animals were divided into two groups: experimental group – with application of the original antimicrobial gel at the stage of hip replacement (n = 6); comparison group – without gel application (n = 6). For morphological studies, animals were sacrificed on the days 10, 45 and 90 after hip replacement, changes in soft tissues and the bone marrow canal were assessed, and cell populations were counted with statistical data processing.Results. The application of the original antimicrobial gel causes statistically significant decrease in the number of neutrophils in the soft tissues surrounding the implant in the comparison group at all stages. Moreover, in the experimental group, at early stages the number of lymphocytes, plasmacytes and macrophages was statistically significantly higher; on the day 45, a statistically significantly larger number of lymphocytes was registered, and on the day 90 – a statistically significantly larger number of multinucleated and epithelioid cells.Conclusion. The experiment histologically confirmed the effectiveness of application of the original antimicrobial gel to stop infectious inflammation in soft tissues and the bone marrow canal during surgical debridement of an osteomyelitic lesion followed by hip replacement. A pronounced giant cell reaction aimed at removing the polyvinylpyrrolidone-based gel requires further research in terms of its outcomes.

Peculiarities of oral microbiota in patients with small and medium-sized dental defects and chronic periodontitis of moderate severity

BACKGROUND: Сhronic generalised periodontitis is one of the most widespread pathologies of the dento-mandibular system. To date, even if there is evidence of bacterial etiology, no biological markers have been developed to qualitatively assess the possibility of inflammation of periodontal tissues or its pathomorphosis to a more severe stage. AIMS: Study of peculiarities of oral microbiota in patients with acquired defects of dental rows in chronic generalised periodontitis of medium severity. MATERIALS AND METHODS: The study participants were 88 people with small/medium dental defects with no clinical signs of periodontal tissue inflammation (the first group) and chronic generalised periodontitis of medium severity (the second group). In order to assess the dental status, an index assessment of periodontal tissues and the intensity of tooth decay was carried out, and the degree of tooth mobility was determined. Using microbiological methods, biomaterial from the mucous membrane of the denture bed tissues was studied with determination of microorganisms composition. DNA of periodontal pathogens was detected and quantified by polymerase-chain reaction. Statistical analysis was performed using the Shapiro-Wilk criterion, t-criterion and χ2 criterion. RESULTS: The mean values of CFE and PMA indices in group 2 patients were 1.5 and 5.7 times higher, respectively, than in group 1. When analysing the composition of microorganisms in biological material from patients with chronic generalised periodontitis of moderate severity, Neisseria spp. were statistically significantly more common (p=0.002), Candida spp. (p=0.035), Enterobacterales (p=0.001), Enterococcus spp. (p=0.03) and statistically significantly lower Corynebacterium spp. (p=0.001) and S. salivarius (p=0.001). In the presence of partial defects of tooth rows in patients, the stated microorganisms formed persistent communities, the nature of symbiotic relations in which determined the clinical manifestations of inflammatory changes in the soft tissues of the periodontium. CONCLUSIONS: The increased incidence of Candida spp. and Enterobacterales in patients with acquired dental defects and periodontal soft tissue inflammation, as well as the formation of persistent relationships between them and antagonistic effects on oral autochthonous bacteria, is of interest for the development of targeted antimicrobial therapy in preparation for dental prosthetic treatment.

Ligament augmentation and reconstruction system (LARS) synthetic grafts are safe and effective for medial collateral ligament and posterolateral corner reconstructions in elite athletes.

This study documents the efficacy and safety of using a Ligament Augmentation and Reconstruction System (LARS) ligament graft to augment extra-articular knee ligament reconstructions in elite athletes by reporting return-to-play(RTP) rates and levels, career longevityand complications. A consecutive series of all extra-articular knee ligament reconstructions augmented by LARS ligaments in elite athletes undertaken by three specialist sports knee surgeons between 2013 and 2020 were reviewed. Seventy-six elite athletes, aged over 16 years old, and more than 2 years postsurgery were included. RTPwas defined as competing at professional levelor national/international level in amateur sport. There were 64 medial collateral ligament (MCL) and 12 posterolateral corner (PLC) reconstructions. Fifty-two (68.4%) underwent concomitant autograft cruciate ligament(s) reconstruction. The mean age was 25.1 years (SD ± 4.5). Most were football (35, 46.1%) or rugby players (35, 46.1%). Sixty-seven athletes (88.2%) RTP with 65 (97.0%) of these playing at the same or higher Tegner level. Fifty-six (83.6%) of the athletes that RTP were still playing at 2 years postsurgery. Twenty (57.1%) of those who had RTP and were more than 5 years postsurgery were still playing at 5 years. Six (7.9%) players required further surgery relating to the LARS/metalwork. One case had soft tissue inflammation adjacent to the proximal end of the synthetic graft, but it is unknown if this was mechanical irritation or a biological reaction. One MCL reruptured 4 years after RTP. Utilising LARS to augment extra-articular knee ligament reconstructions allows 88.2% of athletes with a variety of knee ligament injuries to return to elite sport. The low morbidity rates coupled with 57% of athletes still playing 5 years postsurgery demonstrates that the LARS is safe and effective in these cases. Although there are reports of LARS ligaments being used in MCL and PLC reconstructions, there is very little evidence investigating if they are safe and effective. This study demonstrates that LARS synthetic grafts can be safely used for MCL and PLC reconstructions in elite athletes and they permit a high RTP with a low risk of complications. Level IV.

Soft tissue inflammation around upper third molar cause limited mouth opening: common but overlooked.

The aim of this study was to explore inflammation of soft tissue around the upper third molar as a prevalent cause of limited mouth opening, identify the clinical and radiographic features, and summarize the therapeutic effectiveness of tooth extraction. A retrospective analysis of data from 264 patients with limited mouth opening over the last five years was performed. Among the 264 patients, 24 (9.1%) had inflammation of the soft tissue around the upper third molar, which was the second most common cause of limited mouth opening. Twenty-one of the twenty-four affected patients, with an average mouth opening of 19.1 ± 7.6mm, underwent upper third molar extraction. Gingival tenderness around the upper third molar or maxillary tuberosity mucosa was a characteristic clinical manifestation (p < 0.05). The characteristic features on maxillofacial CT included soft tissue swelling around the upper third molar and gap narrowing between the maxillary nodules and the mandibular ascending branch. Post extraction, the average mouth opening increased to 31.4 ± 4.9mm (p < 0.05), and follow-up CT demonstrated regression of the inflammatory soft tissue around the upper third molar. Inflammation of soft tissue around the upper third molar is a common cause of limited mouth opening. Symptoms of pain associated with the upper third molar and distinctive findings on enhanced maxillofacial CT scans are crucial for diagnosis. Upper third molar extraction yields favorable therapeutic outcomes. Inflammation of the soft tissue around the maxillary third molar commonly causes limited mouth opening, but this phenomenon has long been overlooked. Clarifying this etiology can reduce the number of misdiagnosed patients with restricted mouth opening and enable more efficient treatment for patients.

Evaluation of the Long-Term Success and Patient-Related Outcomes of Zygomatic Implants in Atrophic Maxillary Ridges.

Introduction Zygomatic implants (ZIs) have emerged as a promising option for rehabilitating completely edentulous patients with severe maxillary atrophy. These implants anchor into the zygomatic bone, bypassing the need for extensive grafting procedures. Success rates in dental and craniofacial implant surgeries can be influenced by several surgical factors, including suture techniques, flap design, and treatment planning. The research aimed to present the clinical outcomes and complications in individuals with severely resorbed maxillae who underwent prosthodontic rehabilitation using the Quad Zygoma Protocol (QZP) and the Anatomy-Guided Approach (AGA), focusing on long-term assessment. Material and methods Data for this retrospective study were extracted from the institution's patient database, involving a meticulous review of patient records. This comprehensive examination encompassed demographic data, preoperative assessments, details of surgical procedures, postoperative complications, and subsequent follow-up evaluations. Patients with severe maxillary bone deficiencies resulting in complete edentulism, due to inadequate bone quality and quantity in both anterior and posterior regions, were selected for inclusion. Exclusion criteria were applied to individuals with incomplete records or insufficient follow-up data, as well as those who underwent alternative treatment modalities or presented with comorbidities potentially impacting implant outcomes. The selected patients underwent treatment utilizing the QZP, with each participant subjected to a minimum three-year follow-up period. The implant survival rate, prosthetic success, complications, and Oral Health-Related Quality of Life using the OHIP-14 questionnaire were assessed. Results At the end of the follow-up period involving 12 patients (eight men, four women) with 43 ZIs - 37 from Neodent, four from Nobel Biocare, and two from Norris - with a mean duration of 4.3 years (range: 1.2-5.4), the overall success rate stood at 99.08%, with only 1 out of 42 implants failing. All patients received immediate loading with an acrylic prosthesis, proving effective in 98.2% of cases. The most common issues observed were localized soft tissue inflammation (35.7%) and sinus inflammation (12.5%), occurring after mean follow-up periods of 1.2 and 3.5 years, respectively. In 12 patients, the mean score of the OHIP-14 questionnaire was 1.6 ± 2.6, with a follow-up period of 5 ± 0.6 years. Conclusion The QZP has consistently demonstrated excellent long-term success in restoring severely reduced maxillary structures. An immediate loading approach could aid in stabilizing ZIs through cross-arch support.

Nonionizing diagnostic imaging modalities for visualizing health and pathology of periodontal and peri-implant tissues.

Radiographic examination has been an essential part of the diagnostic workflow in periodontology and implant dentistry. However, radiographic examination unavoidably involves ionizing radiation and its associated risks. Clinicians and researchers have invested considerable efforts in assessing the feasibility and capability of utilizing nonionizing imaging modalities to replace traditional radiographic imaging. Two such modalities have been extensively evaluated in clinical settings, namely, ultrasonography (USG) and magnetic resonance imaging (MRI). Another modality, optical coherence tomography (OCT), has been under investigation more recently. This review aims to provide an overview of the literature and summarize the usage of USG, MRI, and OCT in evaluating health and pathology of periodontal and peri-implant tissues. Clinical studies have shown that USG could accurately measure gingival height and crestal bone level, and classify furcation involvement. Due to physical constraints, USG may be more applicable to the buccal surfaces of the dentition even with an intra-oral probe. Clinical studies have also shown that MRI could visualize the degree of soft-tissue inflammation and osseous edema, the extent of bone loss at furcation involvement sites, and periodontal bone level. However, there was a lack of clinical studies on the evaluation of peri-implant tissues by MRI. Moreover, an MRI machine is very expensive, occupies much space, and requires more time than cone-beam computed tomography (CBCT) or intraoral radiographs to complete a scan. The feasibility of OCT to evaluate periodontal and peri-implant tissues remains to be elucidated, as there are only preclinical studies at the moment. A major shortcoming of OCT is that it may not reach the bottom of the periodontal pocket, particularly for inflammatory conditions, due to the absorption of near-infrared light by hemoglobin. Until future technological breakthroughs finally overcome the limitations of USG, MRI and OCT, the practical imaging modalities for routine diagnostics of periodontal and peri-implant tissues remain to be plain radiographs and CBCTs.