Journal of Clinical Periodontology最新文献

Aim

To investigate whether periodontitis is associated with prevalent and incident metabolic syndrome (MetS).

Materials and Methods

The baseline study included 4183 individuals from a population-based survey (DILGOM) in 2007 and follow-up of 1047 participants with clinical re-examination in 2014. The risk of periodontitis was assessed with saliva biomarkers using a validated, three-group cumulative risk score for periodontitis (CRS I, II and III).

Results

In fully adjusted models, CRS III was associated with prevalent MetS (OR: 1.35, 95% CI [1.11–1.65]), high waist circumference (1.55 95% CI [1.26–1.91]), high blood pressure (1.29 95% CI [1.05–1.59]) and the number of MetS components (β: 0.18, 95% CI [0.06–0.30]). Among participants without MetS at baseline (n = 618), 128 (20.7%) developed MetS during follow-up. In the fully adjusted model, CRS III trended positively with incident MetS (RR: 1.55, 95% CI [ 0.96–2.51]) in the whole population and had a significant positive association in women (2.06, 95% CI [1.08–3.94]), and in non-smokers (1.78, 95% CI [1.01–3.14]). The risk between CRS and incident MetS was mediated via systemic inflammation.

Conclusion

Periodontitis is associated with an increased risk of having metabolic syndrome and, in particular, clearly with the number of MetS components: abdominal obesity, hyperglycaemia and hypertension. Systemic inflammation may elucidate the observed higher risk of incident MetS.

Aim

To investigate whether the gut microbiota–derived metabolite butyrate alleviates the progression of diabetic periodontitis by modulating the Treg/Th17 cell balance.

Materials and Methods

A diabetic periodontitis mouse model was established to assess alveolar bone loss, Treg/Th17 cell subsets, colonic histopathology, faecal microbiota composition and short-chain fatty acid (SCFA) levels. To investigate microbial causality and therapeutic potential, faecal microbiota transplantation (FMT) and butyrate supplementation were conducted.

Results

Mice with diabetic periodontitis exhibited a disrupted Treg/Th17 balance accompanied by colonic epithelial damage and a decreased abundance of SCFA-producing gut microbiota. Faecal SCFA levels showed a downward trend, although the reduction in butyrate was not significant. FMT from diabetic periodontitis mice aggravated periodontal destruction, impaired the colonic mucus barrier and further disturbed Treg/Th17 homeostasis in the recipient mice. These effects were associated with a decrease in SCFA-producing bacteria and faecal butyrate levels. Moreover, butyrate supplementation significantly alleviated periodontal destruction and restored the Treg/Th17 balance.

Conclusion

Gut microbiota dysbiosis contributes to diabetic periodontitis progression through disruption of the Treg/Th17 balance, whereas butyrate, as an immunomodulatory SCFA, may alleviate periodontal tissue destruction by restoring this balance.

Aim

To compare long-term clinical and radiographic outcomes of a single short implant (6 mm) supporting a cantilevered restoration versus two adjacent short implants with non-splinted single crowns over a 7.5-year follow-up and determine which approach is more cost effective.

Materials and Methods

A total of 36 patients with at least a two-tooth gap in the posterior region were randomised to receive either one short implant with a cantilever prosthesis (ONE-C) or two short implants with individual crowns (TWO). Fixed restorations were placed 3–6 months post implantation, and patients were evaluated at baseline and at 6 months and 1, 3, 5 and 7.5 years. Kaplan–Meier curves, mixed-effects models and cost-effectiveness models were used to compare the groups.

Results

Twenty-five patients (15 in ONE-C, 10 in TWO) completed the 7.5-year follow-up. Implant survival was 83.3% in group ONE-C and 86.6% in group TWO, with no significant differences between the groups (p = 0.772). No statistically significant differences were found between groups for marginal bone levels (mean difference −0.16 [95% CI: −0.7 to 0.3] p = 0.57), probing depth (mean difference −0.13 [95% CI: −0.5 to 0.3] p = 0.58), bleeding on probing (mean difference 0.0 [95% CI: −0.0; 0.2] p = 0.31) or plaque levels (mean difference −0.0 [95% CI: −0.1 to 0.1] p = 0.93). Technical complications were more frequent in the ONE-C group (64%) than in the TWO group (36%).

Conclusion

Both treatment approaches showed comparable clinical and radiographic outcomes. Short implants supporting cantilever restorations were generally more cost effective than two short implants but exhibited higher early complication and failure rates, likely related to mechanical overload.

Trial Registration

ClinicalTrials.gov Identifier: NCT01649531

Aim

To evaluate the accuracy and safety of robotic computer-assisted implant surgery (r-CAIS) for transcrestal sinus floor elevation (TSFE) in single-tooth implant placement.

Materials and Methods

In this retrospective case series, we assessed the positional accuracy of r-CAIS combined with TSFE in the posterior maxilla. Preoperative and postoperative cone-beam computed tomography (CBCT) scans were used to determine implant positioning accuracy. Subgroup analyses evaluated the effects of various factors on accuracy. Additionally, complications were recorded and evaluated.

Results

A total of 40 patients and 40 implants were included. Only one case (Case XIX) exhibited a Schneiderian membrane perforation, resulting in a perforation rate of 2.5% (1/40). The mean global coronal and apical deviations were 0.50 ± 0.22 mm and 0.54 ± 0.21 mm, respectively, with an angular deviation of 1.25° ± 0.61°. A linear mixed model (LMM) analysis revealed no statistically significant differences between subgroups (implant position, side of arch, bone quality, implant type, implant size and registration method) and implant deviations (p > 0.05).

Conclusions

r-CAIS showed excellent accuracy and safety for TSFE in single-tooth implant placement. This study suggests r-CAIS can achieve favourable clinical outcomes, although further clinical evidence is needed to confirm its broader efficacy.

Aim

To evaluate the clinical and microbiological effects of a Limosilactobacillus reuteri-based probiotic as an adjunct to subgingival instrumentation in untreated periodontitis patients with diabetes.

Methods

A 6-month, randomised, triple-blinded clinical trial was conducted involving 40 patients, receiving steps 1 and 2 of periodontal therapy, including subgingival instrumentation, and randomised to receive tablets containing L. reuteri or placebo, for 3 months. Clinical and microbiological outcomes as well as glycosylated haemoglobin (HbA1c) concentrations were evaluated at baseline and at 3 and 6 months after therapy.

Results

At 6 months, both groups showed statistically significant reductions in the primary outcome (mean probing depth), with reductions of 0.9 mm in the probiotic group and 0.8 mm in the placebo group, with no significant differences between them. Both groups exhibited reductions in HbA1c levels after 6 months, more in the probiotic group (−0.6% vs. –0.1%), with statistically significant inter-group differences (−0.5%; 95% confidence interval [−1.0; 0.0]; p < 0.001). Microbiological outcomes were similar.

Conclusions

The adjunctive use of a L. reuteri-based probiotic did not provide additional clinical or microbiological benefits, compared to placebo, following subgingival instrumentation in patients with periodontitis and diabetes. However, statistically significant differences in HbA1c levels were observed, with larger reductions in the probiotic group, suggesting a potential systemic benefit.

Trial Registration: The protocol was approved by the Clinical Research Ethics Committee (CEIC) of Hospital Clínico de San Carlos (internal code 19/101-R_X) and registered a priori in ClinicalTrials.gov (identifier NCT04069611)

Background

Periodontitis is a common chronic inflammatory disease. However, drug-related risks and underlying molecular mechanisms remain underexplored from large real-world data.

Methods

We first mined the US Food and Drug Administration Adverse Event Reporting System (FAERS) database to identify drugs disproportionately associated with periodontitis, using four signal detection algorithms and logistic regression for confounder adjustment. Identified drugs were then mapped to their protein targets via DrugBank, followed by pathway enrichment and protein–protein interaction (PPI) network analysis to explore biological relevance. To assess potential causality, we conducted Mendelian randomisation (MR) using cis-pQTLs from UKB-PPP and deCODE cohorts. Finally, we used single-cell RNA sequencing (scRNA-seq) data from gingival tissue and peripheral blood of periodontitis patients to evaluate cell type–specific expression of candidate causal genes.

Results

Five drugs (actonel, aclasta, aredia, amlodipine and avastin) were significantly positively associated with periodontitis based on FAERS. VEGFA showed an association with disease risk (OR = 1.043, p = 0.049) after meta-analysis of two cohorts. scRNA-seq data identified high VEGFA expression in monocytes in both gingival and blood samples of periodontitis patients.

Conclusion

This study uncovered the association between drug and periodontitis and highlighted VEGFA as a potential molecular mediator. Further studies are needed to confirm causality.

Objective

To assess (i) tooth loss (TL) in treated periodontitis (stage III/IV) patients undergoing supportive periodontal care without or with partial denture (PD) (removable [RPD], fixed PD [FPD], implant supported FPD [iFPD]) and (ii) 10-year prosthetic outcomes.

Methods

From 1993 to 2023, comprehensive periodontal therapy including restorative treatment was rendered at the Bundeswehr Central Hospital periodontology outpatient clinic.

Results

Two-hundred and thirty-three patients with generalised stage III/IV periodontitis were treated with a mean follow-up of 21.7 ± 2.7 years: 12 with 21 clasp-retained metal-based RPDs (TL/year 0.4 ± 0.39), 12 with 20 double crown–retained metal-based RPDs (0.35 ± 0.42), 50 with 80 ≥ 5-unit FPD (0.23 ± 0.33) and 27 with 218 implants (0.15 ± 0.22). One-hundred and thirty-two patients with < 5-unit FPDs, no RPDs or iFPDs served as control. The control group exhibited the lowest rate of TL (0.05 ± 0.08). Multivariate analyses revealed age (p < 0.001), smoking > 10 cigarettes/day (p < 0.001) and RPD (p = 0.002)/FPD (p < 0.001) but not iFPD (p = 0.134) to be significantly associated with TL. After 10 years, in 75% patients 67% of the metal-based clasp-retained RPDs; in 80% of patients 75% of double crown RPDs; in 90% of patients 93% of FPD; and in 76% of patients 83% of iFPDs were functional.

Conclusion

Stage III/IV periodontitis patients treated with RPD and FPD have a higher long-term TL rate than controls and iFPD.

Aim

To validate the Diabetes Risk Assessment in Dentistry Score (DDS) in a US population–based sample and compare its performance with the American Diabetes Association (ADA) risk calculator and the Leicester Risk Assessment (LRA).

Methods

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) covering the 2009–2014 cycles. The study focused on participants aged 40 years and older who included complete data for DDS and ADA risk score assessment. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), while decision curve analysis (DCA) was used to evaluate the clinical utility of the model.

Results

Of the 6259 participants included, the average age was 57.3 years (±12.0 years, range: 40–80 years) and the sample was evenly distributed by sex (50.8% female). DDS showed limited discriminative ability with an AUC of 0.64 (95% confidence interval [CI]: 0.62–0.65), and DCA analysis showed higher net benefit than the ‘Treat None’ strategy across most probability thresholds, indicating added clinical value in decision making. The ADA risk calculator and LRA showed an AUC of 0.61 (95% CI: 0.59–0.63) and 0.631 (95% CI: 0.615–0.647), which were below the DDS performance.

Conclusion

The DDS demonstrated acceptable performance for American adults aged 40 years or older, and showed marginally superior performance compared with the ADA diabetes risk calculator and LRA, highlighting its potential utility in dental practice settings as a complementary screening tool.

Aim

To evaluate the impact of ultra-processed foods reduction advice (UPF-RA) on gingivitis treatment and dietary patterns.

Methods

Young adults with gingivitis were randomly assigned to two groups. At baseline, test group participants received UPF-RA. At 8 weeks, professional mechanical plaque removal (PMPR) was carried out, followed by UPF-RA (test group only). Full-mouth periodontal charting and dietary data, collected through the NOVA Food Frequency Questionnaire and the Medi-Lite, were recorded at baseline and at 8 and 16 weeks.

Results

Sixty-six patients (mean age: 23.3 ± 2.3 years; 32 males and 34 females) were included. At 8 weeks, a significant reduction in full-mouth bleeding score (FMBS) was observed in the test group (18.9% ± 8.6% to 14.6% ± 9.0%; p = 0.04), with a concomitant decrease in UPF intake (912.7 ± 511.3 kcal to 446.9 ± 264.6 kcal; p < 0.001). No significant changes in FMBS and UPF consumption were observed in the control group (19.8% ± 9.0% to 19.1% ± 8.6%, p = 0.93; 776.4 ± 453.6 kcal to 775.3 ± 451.03, p = 1.00, respectively). At 16 weeks, gingivitis was resolved in 24% more cases in the test group. Logistic regression identified low UPF intake and UPF-RA as significant predictors of FMBS reduction.

Conclusions

Reduction in UPF consumption improved gingivitis treatment outcomes and participants' dietary quality. Patients with higher UPF consumption showed higher bleeding scores.

Aim

To evaluate the 3-year stability of root coverage outcomes following treatment with a coronally advanced flap (CAF) and a volume-stable, cross-linked xenogeneic collagen matrix (VCMX), either soaked in recombinant human platelet–derived growth factor-BB (rhPDGF, test arm) or sterile saline (control arm).

Methods

Of the original 30 participants in the triple-blind, randomised, placebo-controlled trial, 26 were available for follow-up at 1 and 3 years. The primary outcome was mean root coverage (mRC) at 3 years compared to the 6-month results. Secondary outcomes included complete root coverage, keratinised tissue width, gingival thickness, volumetric and aesthetic changes, patient-reported outcome measures (PROMs) and ultrasonographic tissue properties. Untreated contralateral teeth were also assessed.

Results

From 6 months to 3 years, mRC decreased by 6.7% in the control arm and 7.5% in the test arm (p > 0.05). Over 90% of treated sites maintained a stable gingival margin (≤ 0.5 mm shift). No significant inter-group differences were found for volumetric, aesthetic or PROM outcomes. Ultrasonography revealed increased tissue elasticity in treated sites. In contrast, untreated contralateral sites showed progressive gingival recession and increased hypersensitivity (p < 0.001).

Conclusion

Both VCMX treatments demonstrated stable clinical and ultrasonographic outcomes over 3 years, while untreated sites showed signs of soft-tissue deterioration.