The interrelationship between periodontium and pulp makes the treatment of combined endo-periodontal lesions (EPL) more challenging. It involves successful elimination of both periodontal and endodontic lesion. The current case report represents the efficacy of regenerative potential of enamel matrix derivates (Emdogain®) in endo-periodontal lesion after successful endodontic treatment. A 39-year-old woman presented with EPL on a left first mandibular molar. After the initial 3 months of healing, the clinical examination showed that the furcation involvement still prevailed. A decision was made to use a regenerative procedure using Emdogain®. Fourteen months after the procedure, full periodontal regeneration can be seen on the X-ray. The results demonstrated the synergetic effect of the endodontic and periodontal therapy that changed the prognosis for the tooth.

Background and Objectives: Periodontal diseases are highly prevalent worldwide and have been associated with impaired oral health-related quality of life (OHRQoL). However, the strength and direction of this association remain inconsistent, particularly when sociodemographic and behavioural factors are considered. The aim of this study was to evaluate the independent association between periodontal status and OHRQoL in Bulgarian adults attending a university dental clinic, while accounting for sociodemographic factors and sleep quality, which was included as a clinically relevant behavioural determinant of oral health-related quality of life. Materials and Methods: This cross-sectional study included 504 adult participants (≥18 years) who underwent comprehensive periodontal examination and completed validated questionnaires. OHRQoL was assessed using the culturally adapted Bulgarian version of the Oral Health Impact Profile (OHIP-14), and sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). Due to the skewed distribution of OHIP-14 scores, the outcome was dichotomized at the sample median. Multivariable logistic regression analysis was performed to assess independent associations, adjusting for age, sex, education, financial status, place of residence, and sleep quality. Results: Periodontal status, sex, and sleep quality were independently associated with impaired OHRQoL. Females demonstrated lower odds of impaired OHRQoL compared to males (OR = 0.636; 95% CI: 0.428–0.924; p = 0.025). Poor sleep quality was associated with increased odds of impaired OHRQoL (OR = 1.554; 95% CI: 1.041–2.321; p = 0.031). Periodontitis was significantly associated with impaired OHRQoL (OR = 3.526; 95% CI: 2.073–5.998; p < 0.001), reflecting a complex relationship between clinical periodontal status and subjective health perception. Conclusions: OHRQoL is influenced by a multifactorial framework integrating periodontal status, behavioural factors, and sociodemographic characteristics. These findings highlight the importance of incorporating patient-reported outcomes into periodontal assessment and support a biopsychosocial approach to oral health research.

Biomolecules have gained attention in recent years for their potential to enhance regenerative periodontal therapy. This study compared hyaluronic acid (HA) and enamel matrix derivative (EMD), each combined with a xenogeneic graft, in adults with periodontitis presenting vertical bone loss with an intrabony component ≥3 mm. Seventeen participants contributed 28 defects, assigned in equal numbers to Bio-Oss Collagen^® plus HA gel (hyaDENT BG^®) or Bio-Oss Collagen^® plus EMD (Emdogain^®). Outcomes included reduction in probing pocket depth (PPD), gain in clinical attachment level (CAL), and radiographic measures of residual defect and bone fill, assessed at baseline and 6 months after the surgery. Both approaches produced significant within-group improvements in PPD, CAL, and radiographic bone fill (all p = 0.001). Postoperative values and mean changes did not differ significantly between groups (all p > 0.24). Within the limitations of this small, non-randomized study, the findings indicate that HA gel can achieve clinical and radiographic outcomes comparable to EMD when both are used with a xenogeneic scaffold. These results should be considered preliminary, suggesting that HA may represent a practical and biologically compatible alternative to EMD, particularly in cases where cost, availability, or religious considerations limit its use. Confirmation through larger, randomized, and long-term studies is warranted to validate these observations.

Sleep is a key component of health for every living organism. Insufficient duration and quality of sleep lead to alterations in the systemic immune response, which is bidirectionally associated with periodontal and other systemic inflammatory diseases. The present article aims to analyze key aspects of the pathogenesis of periodontal diseases with focus on essential biomolecules in patients with sleep disturbances, as well as the impact of immunological changes on inflammatory diseases, including periodontitis. Conclusion: Immune regulation that occurs during sleep plays a critical role in maintaining health and controlling a number of systemic inflammatory diseases. This highlights the importance of prevention in patients with sleep disturbances and provides opportunities for new diagnostic approaches.

: Sleep is a key factor in human health. Lack of sleep is associated with many chronic diseases, including periodontal problems. Studies show that sleep disorders can worsen periodontal health and increase the risk of diseases such as gingivitis and periodontitis. The study aims to investigate the importance of sleep for periodontal health among patients aged 18 and older in the Republic of Bulgaria. Methods : In 2025, 504 patients were included in the current study. A detailed periodontal diagnosis and a survey with original questions and validated international instruments (Pittsburgh Sleep Quality Index) were performed. Results : The duration of sleep per day in the studied individuals varies substantially, from 3 to 12 hours. Most often, the night sleep lasted between 6 and 7 hours, in 59.4% of respondents. The examined women slept longer, about a quarter of an hour longer (p = 0.02). The study found approximately the same proportion of people without periodontitis (50.4%) and those with periodontitis at different clinical stages (49.6%). No significant differences were found in the average sleep duration in people without and those with periodontitis, as well as the time for falling asleep (p > 0.05). The entire score index for sleep quali­ty (PSQI) showed significantly lower values among patients with periodontitis (p = 0.049), indicating better sleep quality. Furthermore, patients with periodontitis were more prevalent in the group of PSQI < 5 (46.6% compared to 35.6% in the other group, p = 0.012). We further examined the differences in the questionnaire and found that patients with periodontitis had stayed awake less often. In addition, patients with periodontitis reported fewer sleep disturbance episodes. Conclusion : Periodontal diseases are common conditions and have socially significant potential due to the possibility of loss of dentition and changes in facial aesthetics. At the same time, there is a bidirectional relationship between sleep problems and the systemic response to untreated periodontal disease. Future studies are needed to establish the effect of insufficient sleep on the development and progression of periodontitis.