Frequently, periodontal health and it’s associated oral biofilm has not been addressed in those patients who have systemic health issues, especially those who are not responding to medical treatment via their physician. Oral biofilm may be present in the periodontal sulcus in the absence of clinical disease of periodontal disease (bleeding on probing, gingival inflammation) and periodontal reaction is dependent on the patient’s immune response to the associated bacterial and their byproducts. Increasing evidence has been emerging the past decade connecting oral biofilm with systemic conditions, either initiating them or complicating those medical conditions. The patient’s health needs to be thought of as a whole-body system with connections that may originate in the oral cavity and have distant affects throughout the body. To maximize total health, a coordination in healthcare needs to be a symbiosis between the physician and dentist to eliminate the oral biofilm and aid in prevention of systemic disease or minimize those effects to improve the patient’s overall health and quality of life. Various areas of systemic health have been associated with the bacteria and their byproducts in the oral biofilm. Those include cardiovascular disease, chronic kidney disease, diabetes, pulmonary disease, prostate cancer, colon cancer, pancreatic cancer, pre-term pregnancy, erectile dysfunction Alzheimer’s disease and Rheumatoid arthritis. This article will discuss oral biofilm, its affects systemically and review the medical conditions associated with the oral systemic connection with an extensive review of the literature.

Bioactive alloplastic materials, like beta-tricalcium phosphate (β-TCP) and calcium sulfate (CS), have been extensively researched and are currently used in orthopedic and dental bone regenerative procedures. The purpose of this study was to compare the performance of EthOss versus a bovine xenograft and spontaneous healing. The grafting materials were implanted in standardized 8 mm circular bicortical bone defects in rabbit calvariae. A third similar defect in each animal was left empty for natural healing. Six male rabbits were used. After eight weeks of healing, the animals were euthanized and the bone tissue was analyzed using histology and micro-computed tomography (micro-CT). Defects treated with β-TCP/CS showed the greatest bone regeneration and graft resorption, although differences between groups were not statistically significant. At sites that healed spontaneously, the trabecular number was lower (p < 0.05) and trabecular separation was higher (p < 0.05), compared to sites treated with β-TCP/CS or xenograft. Trabecular thickness was higher at sites treated with the bovine xenograft (p < 0.05) compared to sites filled with β-TCP/CS or sites that healed spontaneously. In conclusion, the novel β-TCP/CS grafting material performed well as a bioactive and biomimetic alloplastic bone substitute when used in cranial defects in this animal model.

Adel-Khattab D, et al. J Periodontal Implant Sci. 2019 Nov;50:e43. https://doi.org/10.5051/jpis.2000040002

The purpose of this study was to investigate the effectiveness of a resorbable alloplastic in situ hardening bone grafting material for alveolar ridge preservation in a swine model. Seven Landrace pigs were used. In each animal, the maxillary left and right deciduous second molars were extracted, and extraction sites were either grafted with a resorbable alloplastic in situ hardening bone substitute, composed of beta-tricalcium phosphate (β-TCP) granules coated with poly(lactic-co-glycolic) acid (PLGA), or left unfilled to heal spontaneously. Animals were euthanized after 12 weeks, and the bone tissue was analyzed histologically and histomorphometrically. Linear changes of ridge width were also clinically measured and analyzed. Pronounced bone regeneration was found in both experimental and control sites, with no statistically significant differences. At the experimental sites, most of the alloplastic grafting material was resorbed and remnants of the graft particles were severely decreased in size. Moreover, experimental sites showed, in a statistically nonsignificant way, less mean horizontal dimensional reduction of the alveolar ridge (7.69%) compared to the control sites (8.86%). In conclusion, the β-TCP/PLGA biomaterial performed well as a biocompatible resorbable in situ hardening bone substitute when placed in intact extraction sockets in this animal model.

Periodontal and peri-implant diseases remain among the most challenging conditions in dentistry, often presenting at advanced stages with significant soft and hard tissue loss. Earlier intervention has consistently been shown to improve predictability and long-term outcomes, yet patients are frequently referred late in the disease process, complicating both surgical and regenerative strategies. Advances in biologically active materials and adjunctive technologies now provide clinicians with an expanded armamentarium to address these complex cases. Growth factor–based therapies, including GEM 21S® and platelet-rich fibrin (PRF), have demonstrated the ability to stimulate both hard and soft tissue regeneration, improving osseointegration and stability around natural dentition and implants. Autogenous dentin grafts offer an osteoinductive scaffold derived from the patient’s own tissues, while amnion-chorion–derived barriers, such as BioXclude®, enhance healing through anti-infective and angiogenic properties. Complementary modalities—including laser therapy, photobiomodulation (PBM), and low magnitude high-frequency vibration (LMHFV)—further accelerate healing, reduce microbial load, and optimize regenerative responses. Clinical cases supported by histologic and radiographic evidence highlight the synergistic benefits of combining biologically driven grafting materials with novel devices designed to enhance surgical outcomes. Collectively, these approaches improve bone-to-implant contact, reduce peri-implant bone loss, and contribute to greater long-term predictability. The integration of these regenerative strategies underscores the importance of biologically based, patient-specific therapies in preserving natural dentition, salvaging compromised implants, and reducing the systemic risks associated with chronic oral inflammation.