Understandably, dental treatment has long focused on what clinicians can see and directly address, namely, bacterial biofilm, diseased tissue, tooth position, bone architecture, and structural defects. Increasingly, however, the dental profession’s understanding of oral disease and treatment is extending beyond these readily observable factors to the biology that governs how individual patients respond to them.
Our two continuing education (CE) articles in this issue illustrate this evolution from different perspectives.
In periodontics, controlling the microbial challenge remains fundamental, but biofilm alone does not fully explain the severity or progression of periodontal destruction. As we see in the first CE, the patient’s immune-inflammatory response plays a key role as well, providing the rationale for host modulation therapy as an adjunct to conventional periodontal treatment. As dentistry learns more about inflammatory pathways, the prospect of influencing those pathways offers intriguing opportunities for increasingly individualized periodontal care.
Yet, inflammation is not simply something to suppress. It is also an essential component of normal physiology, healing, and tissue remodeling. Orthodontic tooth movement offers a particularly compelling example. As discussed in our second CE, mechanical forces initiate an inflammatory response that drives osteoclast activity and bone resorption on the compression side while new bone forms on the tension side. TNF-α is an important participant in this process, raising clinically relevant questions when patients undergoing orthodontic treatment are taking TNF-α inhibitors for autoimmune disease. While animal research suggests that inhibiting this pathway may reduce both tooth movement and root resorption, its clinical significance in humans remains uncertain.
We also feature two innovative case reports. One describes the management of palatal bone loss using a combined therapy of a xenograft–alloplastic collagen scaffold hydrated with rhPDGF-BB to achieve alveolar ridge preservation. In the other, a fully digital workflow is presented for immediate maxillary FP1 rehabilitation.
While the case reports show the importance of preserving treatment plans through careful management of complex clinical constraints, our CE articles highlight what is perhaps a broader direction in dentistry: Treatment increasingly requires us to consider not only what we do to tissues, but how the patient’s biology will respond. As precision dentistry continues to evolve, understanding that response may become every bit as significant as the intervention itself.
Sincerely,
Markus B. Blatz, DMD, PhD
Editor-in-Chief
markus.blatz@conexiant.com
