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Developments in engineering and biological science technologies in recent years have increased the capacity of tissue engineering to be utilized in medical and dental disciplines more effectively. Numerous studies have been conducted using stem cells and scaffolding materials to investigate the potential of regenerative periodontal procedures. The scope of this chapter is to review the nature of periodontal regeneration, the current understanding of periodontal regenerative protocols and surgical applications, recent developments in periodontal tissue engineering, variables that affect clinical applications of periodontal regeneration, and to discuss the limitations and the future directions of regenerative periodontal research.

Periodontitis is a chronic inflammatory disease characterized by destruction of the supporting structures of teeth caused by development of dental plaques and accumulation of microorganism around the gingival tissue. Curcumin has been shown to improve clinical parameters in periodontal diseases. However, the efficacy of curcumin in the elimination of periodontal pathogens is not clearly defined. The purpose of this study was to carry out a systematic review of the antibacterial activity of curcumin against periodontal pathogens. An electronic literature search in Medline, Scopus, Science Direct, Web of Science, Cochrane library, and Google scholar was performed up to February 29, 2020, to identify studies assessing the antibacterial activity of curcumin against periodontal pathogens. From 1238 publications, three clinical trials and five in vitro studies met the eligibility criteria. All three clinical studies reported improvement in restoring gingival health in clinical and microbiological parameters, following adjunctive use of curcumin for treatment of periodontitis. All five in vitro studies showed that curcumin could inhibit the growth of bacterial strains. Three of the five in vitro studies evaluated the effect of curcumin on mixed biofilm of periopathogens, which showed a significant inhibitory effect of curcumin on periodontal biofilms. This systematic review found that curcumin has antibacterial activity against periopathogens. The anti-biofilm activity of curcumin is reported as one of the mechanisms for this phenomenon. Curcumin could improve the clinical parameters of periodontal tissue not only by inhibition of the pathogens but also by modulating the host response.

In this paper, the authors consider how to label and save a large number of images that should be predicted in a single file. The technique of automatic labeling the data set with the finite element model for training of artificial neural network in tomography are proposed. A simple transparent example of thirty-two images to be predicted in a single HDF5 file training of artificial neural network in tomography show accuracy 100% for training set as well for the test set. Then this technique is able to build an information model of salivary immune and periodontal status and to evaluate the correlation between salivary immunoglobulin level, inflammation in periodontal tissues and orthodontic pathology. For this study, patients were divided into the following groups: 76 patients with chronic gingivitis and atopic diseases (group 1), among which the proposed treatment was used; 50 patients without clinical signs of gingivitis with atopic diseases (group 2) for which specific prevention was prescribed; 30 patients with chronic gingivitis and atopic diseases to which the standard treatment of gingivitis has been applied (group 3); 30 patients without clinical signs of gingivitis with atopic diseases using traditional preventive measures (group 4); 35 patients made control group with intact periodontal tissues without somatic pathology (group 5). This study was conducted to assess the state of lipid peroxidation in the oral liquid and the periodontal disease and to detect the correlation between the level of antioxidants in children and inflammation in periodontal tissues by means of regression analyses. The results showed changes in the antioxidant balance in children with atopy that were expressed in an increase in malondialdehyde level, a decrease in superoxide dismutase activity, and a level of reduced glutathione. These indicators can be considered as biological markers of the development of gingivitis at the preclinical stage in children against atopic diseases.

Partial extraction therapies (PET) are a group of clinical procedures carried out wherein a part of the tooth is left behind in the alveolar socket at the time of extraction and the implant is placed either at the same time or later. This technique makes the body believe that the tooth is in the bone and makes it behave as such. The procedure relies on the concept that, the alveolar bone resorption is a consequence of loss of bundle bone and the only way to preserve the bundle bone is to retain the periodontal ligament attachment to it. This chapter will cover the biology of the periodontal tissues and the evolution of PET.

The concept and relevant literature related to minimally invasive periodontal surgery is reviewed. The original MIS procedure for bone regeneration is described as well as the modification of MIS for the MIST and M-MIST procedure. The development and introduction of the videoscope for periodontal procedures are also reviewed. The videoscope’s ability to visualize and treat periodontal defect through much smaller surgical openings than the MIS or MIST techniques has led to the development of the videoscope-assisted minimally invasive surgery (VMIS) approach. The VMIS procedure is reviewed in detail. The results from long-term studies of the VMIS procedure are reported. A procedure for using the videoscope and applying the concepts of VMIS to the problem of regenerating bone in instances of peri-implantitis is also presented. The use of small incisions that produce minimal trauma and preserve most of the blood supply of the periodontal and peri-implant tissues results in improved regenerative results, minimal to no negative esthetic outcomes, and little or no patient discomfort. Minimally invasive procedures are a reliable method to regenerate periodontal tissues.

At present, various tissue engineering strategies in the regenerative medicine have been developed for multiple tissue regeneration and integrative structure formations in musculoskeletal system. However, the regenerations of dental tissues or tooth-supportive structures are still challenging due to the micro-interfacial compartmentalization of multiple tissues, their integrations for systematic responses, and spatiotemporal organizations of engineered fibrous tissues. In particular, the biomaterial-based approaches are limitedly investigated for spatiotemporal controls of periodontal regenerations and challenging to promote micron-scaled interfacial tissue compartmentalization with their integrations for functioning restorations. This chapter demonstrates biomaterial applications for periodontal tissue engineering and the advanced 3D fabrication technologies for preclinical applications and the limited clinical trial using 3D scaffolding systems.

To fully regenerate the periodontal tissues remains a challenge in our daily practice. Periodontal regeneration is a complex process involving a series of cellular and molecular events. In the last two decades, significant advances have been made in applying proteins and peptides to treat periodontal osseous defects. Several products are currently available and a few others are under development. Stem cell therapy has also been vigorously investigated for regenerating craniofacial tissues including periodontia. In this chapter, we review the current status of protein- and cell-based therapies for periodontal regeneration, with an emphasis on products that have been tested in clinical studies.

Periodontal diseases have become exceedingly widespread, and management of the defects due to periodontitis has been a great challenge in periodontal therapies. In the last two decades, concerted efforts have aimed to improve periodontal tissue regeneration by bone grafting and guided tissue regeneration. Recent studies have focused on tissue engineering (TE) techniques for periodontal regeneration using stem cells, growth factors, and scaffolds to grow new functional tissues, rather than building replacements for lost periodontal tissues. The future of periodontal regeneration research requires an understanding of current findings, which in turn highlights the need for future research. In this chapter, we review recent progress in periodontal tissue regeneration and current tissue engineering approaches. The advantages and disadvantages of this method in clinical practice will be also discussed based on recent studies.

OBJECTIVE: The need for orthodontic treatment continues to increase. Strategies that shorten the treatment course and reduce discomfort are most welcome in clinic. Circadian rhythm plays important role in various physiological processes, including bone formation. This study intended to depict a possible circadian releasing property of the osteogenic factors within the periodontal tissue during orthodontic treatment, which may direct a more efficient and satisfactory orthodontic treatment to the patient. METHODS: Primary periodontal ligament cells (PDLCs) were obtained from the Sprague-Dawley (SD) rats. An equibiaxial strain value of 12% was applied on rat PDLCs (rPDLCs). After 2 h stimuli of 10(−7) M dexamethasone (DX), the osteogenic genes’ expressions were detected by real-time polymerase chain reaction (RT-PCR) at Zeitgeber times 0, 4, 8, 12, 16, 20, and 24. An orthodontic appliance was placed on 45 SD rats. Animals were maintained under 12-h light/dark periods and euthanized at 9 time points over the diurnal cycle. The orthodontic sensitive tissues of the mesial root of the maxillary first molar were collected for RT-PCR and immunohistological assay. RESULTS: The rPDLCs displayed typical fibroblastic spindle shape, and subcultured steadily in vitro. Induced by DX, the mRNA expression of Col-1, OPN, and IBSP within the loaded/unloaded rPDLCs oscillated as that of the main clock gene Per-1. The osteogenic genes’ expressions as well as the protein releases sustained a circadian oscillation trend in vivo. CONCLUSIONS: This study indicates the existence of a circadian rhythm of the osteogenic factors within the orthodontic sensitive tissues, which highlights the importance of precise timing of force loading in further orthodontic treatment. Thus, a periodicity pattern of orthodontic traction at night may prove a more efficient tooth movement while minimizing the treatment window and discomfort complains.

According to a systematic review conducted by Zweers et al. [1], three gingival biotypes can be clinically distinguished: Normal, thin scalloped, and thick flat according to the differences in the shape, position, and thickness of the marginal periodontal tissues [2]. The authors reported that the dental, gingival, and bony dimensions represent a weak to moderate association. Uniform positive associations were found only between gingival thickness, keratinized tissue, and bone morphotype. Hence, the thin gingival biotype is characterized by a scalloped gingival outline, relatively thin with a narrow band of keratinized tissue. It confirms the finding of the in vivo study by Cook et al. [3] who found that thin gingival biotype was associated with narrow band of keratinized tissue, thin underlying buccal bone, and a big distance from cementoenamel junction to the bone crest (Figs. 2.1 and 2.2).

The oral manifestations of hematologic disorders are variable and sometimes resemble other local or systemic conditions. In addition to the cutaneous and systemic findings, the mucous membranes, periodontal tissues, salivary glands, and perioral tissues are often impacted. The clinical constellation may include nonspecific findings such as hemorrhage; fungal, viral, and bacterial infections; ulcerations; and edema. When discussing hematologic disorders, white blood cell, red blood cell, and platelet dyscrasias must be considered.

Exposure to ultrasound during the inflammatory phase of periodontal tissue repair leads to an acceleration of this phase, which may eventually lead to an anti-inflammatory effect by low-intensity pulsed ultrasound (LIPUS) exposure. LIPUS has also been shown to enhance collagen synthesis by fibroblasts. As a consequence, LIPUS may be a promising candidate of treatment remedy for periodontal diseases such as periodontitis and orthodontically induced root resorption. Recent in vitro studies suggested that LIPUS promotes osteogenic differentiation of human periodontal ligament (PDL) cells, which is associated with upregulation of Runx2 and integrin β1 and activation of bone morphogenetic protein-smad signaling. Furthermore, recent in vivo studies have shown that LIPUS can enhance periodontal tissue repair and regeneration, especially if combined with the other treatment remedies for periodontal diseases such as guided tissue regeneration (GTR). These suggest that LIPUS could potentially enhance periodontal tissue repair and regeneration combined with GTR and provide therapeutic benefits in periodontal tissue regeneration.

Gingival recession is a highly prevalent problem affecting individuals of all ages worldwide. Before considering any therapeutic strategies for gingival recession defects, it is important to identify the underlying etiological factors that contributed to the development of the clinical condition. The main etiological factors for gingival recession are plaque-induced periodontal inflammation and mechanical trauma caused by improper toothbrushing habits. Several other predisposing and precipitating factors have also been implicated in the etiology of gingival recession. The aim of this chapter is to summarize the different etiological factors contributing to the development of gingival recession. Furthermore, the prevalence of gingival recession among different populations will be described.

There is rising interest about influences of periodontal diseases on systemic health, while traditional measures cannot quantify periodontal inflammation. Confusing case definitions make the need to quantify periodontal inflammation greater than ever. Modern measures of periodontal inflammation depend on metabolism-mediated changes in salivary metabolites (salivary metabolomics)—an extra mile in salivary diagnostics.

Previous chapters of this book have discussed the importance of subgingival microbial colonization and of the inflammatory-immune response as triggers of periodontal tissue breakdown. In fact, it appears clear that periodontal health or pathology is the result of the interaction between the human host and its invading microbes. Or perhaps we should not define them as ‘invading’, since it is well known that microbes not only coexist with their human host, but also provide multiple vital functions for the survival of the host itself [1]. Compelling evidence has now emerged to suggest that host genetic variants have a fundamental effect in regulating the host’s relationships with the microbial ‘guests’ and a better knowledge of how these effects are implemented is crucial in the understanding of disease processes. This chapter will review the evidence on the effect of host genetic factors on periodontal microbial colonization and will provide examples of how this could have an impact in clinical practice.

Periodontal disease is a current public health problem compromising heavily patients’ quality of life. Scientific evidence on treatment of periodontal disease is associated with a high degree of variability in reported outcomes and potential efficacy. Thus, regeneration of periodontal tissues through safe and efficient treatment protocols remains an important challenge. Moreover, conventional therapies result habitually in repair rather than regeneration of deteriorated tissues. Recent development in tissue engineering and regenerative medicine has paved the path for new treatment approaches. Mesenchymal stem cells are an outstanding candidate for tissue regeneration. They are the key element of combined tissue engineering therapies for periodontal regeneration. Related scientific evidence has highlighted exciting potential therapeutic utilization accompanied by numerous limitations and future challenges. The present chapter has been assembled considering these aspects and with the hope of providing investigators with solid bases for the state of art and potential future directions of periodontal regenerative therapies.

Several techniques have been used within the last 170 years to lighten discolored endodontically treated teeth. Internal whitening or intracoronal whitening offers some advantages over more invasive treatments, as: (1) it is relatively easy to carry out; (2) it involves the removal of minimal tooth structure; and (3) the cost of treatment is low compared to that of other restorative options including full- and partial-coverage restorations.

Classification of partially edentulous arches is vital in order to ensure effective communication between dental professionals and to discuss the most suitable treatment plan for patients. Partially edentulous arches have been classified according to several methods. The Kennedy classification proposed by Dr. E. Kennedy is the most widely accepted and used classification method due to its simplicity and ease of application, with nearly 65,000 possible combinations of partially edentulous arches. Although this system does not give an information about the condition of the teeth and periodontal tissue, it allows easy visualization of the arches, differentiation between free end and tooth-bounded partially edentulous arches, and logical approach to design. Therefore, only Kennedy classification is described in this book. Additionally, a classification system (Implant-Corrected Kennedy/ICK) for partially edentulous arches incorporating implants placed or to be placed for an RPD is described and used. It is proposed by Al-Johany SS. and Andres C. and based, with modifications, on the Kennedy classification system.

Dental materials are used for the replacement of destroyed or lost structures and for the restoration of disturbed functions of the orofacial organ (hard tooth substance, teeth, and soft tissues of the mouth). Among the main challenges in restorative dentistry in Indonesia are the caries, recurrent caries due to the leakage or restoration failure that may lead to infection of the pulp and periodontal tissue. Therefore, it is desirable to develop dental materials having ability to seal the marginal interface between material and tooth structure, bioactivity to promote remineralization and good bonding with tooth structure and antimicrobial capabilities. This chapter describes dental materials in restorative dentistry, the most common dental problems in Indonesia, and the development of local bioactive dental materials by utilizing the diversity of natural resources in Indonesia.

The past decades have significantly widened the perspectives of the chronic oral infectious disease known as periodontitis. The disease is regarded as a bacterial infection resulting in low-grade inflammation of the periodontal tissues, and both the associated release of pro-inflammatory mediators and the presence of bacteria in the periodontal pockets, which, as the result of daily procedures, may spread after penetration of the vasculature, are possible mediators of systemic consequences. This chapter deals with the possible association between periodontitis and diabetes mellitus which is believed to possess in a two-way interrelationship.

The periodontal tissues and pulp–dentine complex form an intimate continuum through which pathological changes of either one may lead to infection of the other. The management of such lesions can be fraught with diagnostic and therapeutic difficulty requiring a methodical multidisciplinary approach. Traditional classifications of endodontic–periodontal lesions are largely academic and based inappropriately on an attempt to identify the primary source of infection. Treatment and prognosis of endodontic–periodontal lesions depend on the cause and the correct diagnosis of each tissue. It is critical to determine whether the lesion is primarily endodontic or periodontal in origin since this will determine which treatment plan is instigated. True combined lesions require a staged approach with endodontic treatment initiated followed by a 2–3-month review to reassess outcome. Appropriate periodontal therapy can then be initiated followed by further review to assess outcome. The long-term prognosis for such cases will be guarded requiring not only careful clinical management but also patient motivation.

For many people, the smile is considered the “business card” because it may reflect a part of the individual behavior and feeling of each one of us. Healthy, harmonious, and pleasant smiles are associated to four elements