Periodontitis is a chronic immune-inflammatory disease in which dysbiotic microbial communities and sustained host responses disrupt the gingiva, periodontal ligament (PDL), cementum, and alveolar bone. Because these tissues form an integrated attachment apparatus, effective regeneration requires coordinated control of inflammation and reconstruction of soft and mineralized tissues. Extracellular vesicles (EVs) function as intercellular mediators at this immune-regenerative interface by transferring proteins, lipids, and nucleic acids among immune, stromal, vascular, and bone-remodeling cells. This review synthesizes how EVs connect immune reprogramming, microenvironmental remodeling, and tissue-specific repair in periodontitis. Across experimental studies, EVs regulate macrophage activation and T-cell balance, modulate inflammatory, oxidative, vascular, and osteoclastogenic signaling, and influence the survival, migration, and differentiation of gingival, PDL, cementoblast, and osteoblast-lineage cells. Together, these actions link inflammatory resolution to the cellular processes required for gingival healing, alveolar bone formation, cementogenesis, and re-establishment of the PDL-cementum-bone interface. EV activity is shaped by donor-cell identity and physiological state, culture and separation procedures, molecular cargo, dose, recipient cell, and disease context; this context dependence explains why different EV preparations can produce reparative or pathogenic responses. Cargo engineering, surface modification, and biomaterial-assisted local delivery offer routes to enhance potency, cellular interaction, and retention within periodontal defects. Translation now depends on defining reproducible EV products, establishing mechanism-linked potency assays, standardizing dose and quality control, and evaluating safety and function in disease-relevant models. Current evidence is predominantly preclinical and indicates that process-defined EV preparations can link inflammatory resolution with tissue reconstruction as adjuncts to infection control and established periodontal regenerative procedures.

This pilot randomized study compared the clinical effectiveness and patient-reported outcomes of the novel Overlapping Rotated Double (NORD) flap with the Subepithelial Connective Tissue Graft (SCTG) for the management of single isolated RT1 gingival recession defects. Thirty-two systemically healthy adults were randomly assigned to either the NORD or SCTG group. Primary outcomes included reduction in recession depth, percentage of root coverage, and patient-reported measures, while secondary outcomes included gingival thickness, width of attached gingiva, probing depth, and clinical attachment level. The NORD technique utilized a rotated double-flap design using adjacent tissues, whereas the SCTG group was treated with a pouch-and-tunnel approach with connective tissue graft placement. Clinical parameters were recorded at 14-days, 1-month, and 6-months postoperatively. Data were analyzed using analysis of covariance (ANCOVA) with adjustment for baseline values, age, and gingival phenotype. Both procedures resulted in significant clinical improvement. Mean recession depth reduction was 1.66±0.18mm for NORD and 1.48±0.18mm for SCTG (p=0.516), with root coverage of 76.6% and 72.05%, respectively. Secondary clinical outcomes were comparable between groups; however, NORD demonstrated advantages in patient-reported outcomes, including lower postoperative pain, absence of donor-site morbidity, and shorter surgical duration, suggesting it may be a conservative and time-efficient alternative to SCTG.

Introduction Gingival recession is a common mucogingival condition that may result in dentinal hypersensitivity, root caries, cervical abrasion, and compromised aesthetics, particularly in the maxillary anterior region. Various root coverage procedures have been proposed for the management of gingival recession defects. Among the available treatment options, the coronally advanced flap (CAF) and semilunar coronally repositioned flap (SCRF) are relatively simple techniques for the treatment of isolated shallow recession defects. Aim This study aimed to compare the clinical outcomes of CAF and SCRF in the treatment of Miller's class I gingival recession defects in maxillary anterior teeth. Materials and methods Twenty patients presenting with isolated Miller's class I gingival recession defects in maxillary anterior teeth were enrolled in this randomized, single-blind controlled clinical study. Patients were randomly allocated into two groups (n = 10 each). Group A received treatment with CAF, whereas Group B was treated using the SCRF technique. Clinical parameters including recession height (RH), probing depth (PD), clinical attachment level (CAL), and width of keratinized gingiva (WKG) were recorded at baseline, at three months, and at six months postoperatively. Additionally, the percentage of root coverage was calculated at six months. Results Both treatment modalities resulted in improvement of clinical parameters. Notably, SCRF was found to be a simple, rapid, and sutureless procedure with favorable gain in the WKG. However, CAF demonstrated superior clinical outcomes with respect to percentage of root coverage, frequency of complete root coverage, and gain in CAL at six months. Conclusion Both CAF and SCRF were effective in the management of Miller's class I gingival recession defects. However, CAF achieved superior root coverage and attachment gain compared with SCRF, suggesting that CAF remains the preferred treatment modality for predictable root coverage in isolated maxillary anterior recession defects.

This study investigated the regional and direction-specific tensile properties of native human oral mucosal tissues. Tissue specimens were harvested from three distinct maxillary regions, namely the hard palate, attached gingiva, and alveolar mucosa from 11 partially dentate donors, totaling 34 specimens. Using the osmotic stress protocol to standardize water content, specimens underwent uniaxial tensile testing. Mechanical parameters, including elastic modulus, Cauchy stress and stretch at failure, were calculated and statistically analyzed. The attached gingiva yielded a higher elastic modulus than the alveolar mucosa and a greater Cauchy stress at failure than both the alveolar mucosa and the hard palate, while stretch at failure was similar across all regions examined. No statistically significant direction-dependent differences were detected within the investigated regions. The attached gingiva demonstrated greater variability in elastic modulus and stress values. Collagen fiber coherency and rupture patterns differed between anatomical regions; however, collagen coherency showed no significant overall correlation with elastic modulus or Cauchy stress at failure. Furthermore, failure patterns appear to be site-specific. The present study constitutes the first comprehensive morpho-mechanical characterization of human maxillary mucosa, thereby providing novel insight into region-specific mechanical resilience. These findings hold significant relevance for the optimization of prosthetic design, the advancement of oral biomechanical understanding, and the refinement of computational models in both clinical and bioengineering contexts.

Background: This article introduces a clinically oriented, anatomy-based classification of subgingival margins. The proposed system categorizes margins into distinct zones based on their relationship with gingival and periodontal tissues and links each zone to appropriate restorative strategies. Methods: The classification is based on established principles of periodontal anatomy and restorative dentistry, as well as clinical considerations related to accessibility, isolation, and matrix placement. Three zones are proposed: (1) margins located within the free gingiva, which are generally accessible and manageable with rubber dam isolation; (2) margins extending into the junctional epithelium and supracrestal tissue attachment, where additional measures, including matrices and wedges, are often required to achieve adequate isolation and adaptation; and (3) margins located at or below the alveolar bone crest, which have traditionally required surgical management but may, in selected cases, be managed with advanced matrix techniques. Results: The proposed classification helps clinicians assess the complexity of subgingival margins before performing deep margin elevation (DME) and provides guidance for selecting appropriate clinical procedures according to margin depth and anatomical location. Conclusions: This classification provides a practical framework for selecting appropriate isolation techniques and treatment strategies to improve the predictability of restorative outcomes. Further clinical research is needed to evaluate its validity and its effects on periodontal health and long-term restorative outcomes.

Oral pyogenic granuloma (OPG) is a reactive vascular lesion that may worsen during orthodontic treatment due to biofilm-induced inflammation. This clinical case describes the surgical and mucogingival management of an OPG associated with fixed orthodontic appliances in an adolescent patient. A 12-year-old male patient presented with an oval, pedunculated lesion with a smooth surface and soft consistency, measuring approximately 8.5 × 6.5 mm, located on the attached gingiva adjacent to tooth #21. Therapeutic management consisted of complete surgical removal of the lesion under local anesthesia; additionally, mucogingival management was performed via partial dissection, lateral displacement, and coronal advancement of the tissue to promote preservation of the gingival architecture. Histopathological examination confirmed the diagnosis of OPG. Adequate healing was observed during clinical follow-up. This case highlights the importance of identifying reactive gingival lesions in young patients with fixed orthodontic appliances, in whom inflammatory and hormonal factors may play a parallel role.