Journal of periodontal research最新文献

Aims: Although static navigation (sCAIS) has been shown to be a well-established technique in clinical practice, innovative methods such as dynamic navigation (dCAIS) are currently on the rise. The objective of this systematic review is to compare the accuracy of freehand (FH), sCAIS, and dCAIS.

Methods: Following PRISMA guidelines, a systematic review and meta-analysis with electronic and manual searches for comparative studies on transfer accuracy (TA) of freehand dental implant placement versus sCAIS versus dCAIS in pre-clinical and clinical studies was conducted. The main outcome was TA between planned and placed implant positions, measured via axial, global coronal, and global apical deviations reported as mean values with standard deviation.

Results: A total of 37 of 4511 screened articles were included, reporting data on 3104 implants across 606 models and 801 patients. Clinical studies revealed no statistically significant differences in TA between dCAIS and sCAIS. The pooled mean deviations were as follows: axial deviation -0.09° [95% CI: -0.66 to 0.48; PI: -2.11; 1.93], global coronal deviation -0.03 mm [95% CI: -0.16 to 0.11; PI: -0.47; 0.42], and global apical deviation -0.24 mm [95% CI: -0.48 to 0.00; PI: -1.12; 0.64]. However, subgroup analysis including RCTs only demonstrated that both sCAIS and dCAIS achieved statistically significantly higher accuracy in all investigated deviation parameters compared to the freehand protocol.

Conclusion: Both static and dynamic computer-assisted implant placement techniques are considered reliable methods for enhancing accurate implant positioning, offering significantly greater accuracy compared to the conventional freehand approach. The presence of bias risks and notable heterogeneity in the included investigations warrants careful consideration of the results.

Aim: To characterize the impact of periodontitis and of Steps I-II of periodontal therapy on microbiome composition, function, and metabolic output across the oral and gut environments.

Methods: A multi-omics analysis was performed on saliva and stool samples collected from 50 systemically healthy individuals with and without Stage III-IV periodontitis. For participants with periodontitis, samples were analyzed both at baseline and 3 months after Steps I-II of periodontal therapy. High-throughput whole metagenome sequencing was used to profile microbial taxa and functional genes, NMR-based metabolomics profiled host-microbial metabolites. Single-omic differential abundance analysis between healthy samples and periodontitis samples was performed with MaAsLin2, while analysis between pre- and post-treatment was conducted with timeOmics. Variable selection and subsequent supervised multivariate analysis to determine group-separating markers utilized multi-level sparse Partial Least Squares Discriminant Analysis (sPLS-DA) through mixOmics. KEGG pathway enrichment was analyzed using clusterProfiler, whereas multi-omic data integration was performed with multi-block Partial Least Squares regression analysis.

Results: Periodontitis was associated with significant compositional and functional changes in both saliva and stool, with increased abundance of pathobionts and loss of health-associated taxa in both niches. A subset of species was shared across oral and gut habitats, with detectable differences across clinical groups. As functional potential, periodontitis enriched microbial pro-inflammatory pathways (lipopolysaccharide biosynthesis, bacterial motility) and depleted beneficial short-chain fatty acid (SCFA)- and vitamin-producing functions. Metabolomic profiles revealed reduced SCFAs and amino acids in periodontitis, with elevated pro-inflammatory metabolites (succinate, trimethylamine) in both saliva and stool. Following therapy, microbial communities and their metabolic output partially reverted toward health-associated profiles, particularly in saliva. Stool samples showed subtler but consistent shifts, including a decrease in some typically oral species and decreased succinate and methylamine and restoration of amino acid and SCFA-related metabolites.

Conclusions: Periodontitis is associated with coordinated microbial and metabolic signatures across the oral and gut environments. Non-surgical periodontal therapy promotes partial ecological restoration in both niches, supporting the view of oral health as a modifiable target for influencing systemic microbial homeostasis.

Trial registration: ClinicalTrials.gov identification number: NCT04826926.

Aim: To examine the impact of emulated natural tooth preservation or dental rehabilitation scenarios on diet quality among older adults in the United States, assessing what diet quality would be if people's dentition or rehabilitation status were improved.

Methods: Data from 2606 participants aged ≥ 60 across four NHANES cycles (2011-2018) were analyzed. Dentition status and prosthetic rehabilitation were clinically assessed, and diet quality was measured using the Healthy Eating Index (HEI)-2020. The modified treatment policies (MTP) framework was used to emulate hypothetical interventions of retaining natural teeth or providing prosthetic rehabilitation. Odds ratios (OR) for achieving better diet quality under each scenario were estimated using doubly robust targeted maximum likelihood estimation (TMLE).

Results: If all participants retained ≥ 25 teeth, the likelihood of achieving better HEI scores increased by 51% (OR = 1.51, 95% CI: 1.32-1.69). In a pragmatic scenario where each dentition group was shifted up by one level (edentulous → 1-9 teeth, 1-9 teeth → 10-19 teeth, 10-19 teeth → 20-25 teeth, 1-9 teeth → ≥ 25 teeth), the population had a 20% higher likelihood of achieving better diet quality (OR = 1.22, 95% CI: 1.14-1.29). Prosthetic rehabilitation yielded comparatively smaller effects, with rehabilitation in individuals with < 25 teeth improving the likelihood of better diet quality by 8% (OR = 1.08, 95% CI: 1.03-1.12).

Conclusion: The present observational study suggests that preserving natural teeth has a stronger population-level impact on diet quality than prosthetic rehabilitation replacing missing teeth in older adults.

This RCT offers a nuanced understanding of nonsurgical peri-implantitis management (air polishing with erythritol versus ultrasonic instrumentation, in combination with systemic metronidazole), integrating both clinical and patient-centered outcomes. The results showed that the ultrasonic instrumentation reduced probing depth and bleeding on probing, throughout the 12-month period.

While periodontitis is globally recognized as a significant public health problem, its common definition as a plaque-based inflammatory condition is incomplete. Disease progression, personal experience, and treatment are shaped by social, economic, and structural forces largely invisible in clinical practice and policy. A lens from medical anthropology helps us see periodontitis as more than a clinical diagnosis; it is a lived experience, deeply entangled with a person's social world. The physical reality of inflammation translates into profound emotional distress-from the shame and stigma of bleeding gums and gingival recession to the tangible fear of tooth loss. This personal suffering is often intensified by a societal focus on individual blame, which masks systemic barriers like poor insurance coverage and the simple lack of local care. Ultimately, the cultural language and assumptions surrounding oral health-what anthropologists term explanatory models and semantic networks-powerfully influence everything from a patient's decisions to the public's perception of the disease itself. We argue for a more culturally attuned approach to periodontal health-one that prioritizes prevention, centers the patient's lived experience, and confronts the systemic roots of oral health inequities. By integrating the insights of anthropology with the science of periodontics, we believe we can build a more complete model of care that leads to equitable health outcomes, creating policies and practices that acknowledge both microbial causes and patients' lived realities.

Aim: To examine the association between the oral microbiome, periodontitis, and edentulism in a nationally representative sample of the U.S.

Population:

Methods: A total of 5299 adults aged 30-69 years were examined (NHANES 2009-2012). Oral rinse samples were collected and analyzed through 16S rRNA gene sequencing. Periodontitis presence, stage, extent, and grade were assessed according to the 2017 AAP/EFP classification using the ACES framework, with edentulism considered as a distinct category. Bacterial diversity and taxonomic composition were evaluated using alpha and beta diversity metrics and multivariable linear models (MaAsLin2), adjusted for relevant confounders.

Results: Alpha diversity increased with periodontitis severity, extent, and grade, peaking in Stage III generalized periodontitis. In Stage IV, extensive tooth loss was associated with a decrease in alpha diversity. Edentulous individuals exhibited the lowest alpha diversity, falling below levels observed in those without periodontitis. Beta diversity differences across periodontitis severity, extent, and grade were subtle (< 0.2%). Taxonomically, increasing severity, extent, and grade of periodontitis were associated with enrichment of established periodontitis-related genera (e.g., Dialister, Filifactor, Fusobacterium, Porphyromonas, Prevotella, Tannerella) and Jonquetella, alongside depletion of health-related genera (e.g., Rothia, Veillonella). A total of 13 genera were commonly altered in both edentulous individuals and those with Stage III-IV periodontitis, relative to participants with no or localized Stage I-II disease.

Conclusion: Periodontitis is characterized by an increase in alpha diversity with advancing severity, extent, and grade, followed by a decline with extensive tooth loss and edentulism. However, it accounted for only a small fraction of the overall variation in oral microbiome composition. Taxonomic shifts included enrichment of established periodontitis-related genera and Jonquetella, alongside depletion of health-related genera. The persistence of periodontitis-associated bacteria in edentulous individuals may have important implications for implant dentistry.

We have previously described Porphyromonas gingivalis as a keystone pathogen due to its critical contribution to the development of periodontitis. Healthy periodontal tissue contains an active innate host defense system made in response to commensal bacterial colonization that facilitates an orchestrated expression of protective host mediators. We designated P. gingivalis as a keystone pathogen since it impairs host defense, leading to the overgrowth of oral commensal bacteria, altering a protective host surveillance response to a destructive, increased host inflammatory response. In addition, P. gingivalis uncouples inflammation from bactericidal activity, which manipulates the host inflammatory response in a way that promotes bone loss but not bacterial clearance. In this review, we update the keystone hypothesis by summarizing recent key fields of research that enhance our understanding of the keystone properties of this organism. For example, the last decade has witnessed significant progress in the characterization of the mechanism of export of some of the critical virulence determinants of P. gingivalis via the type IX secretion system (T9SS). These include, but are not limited to, the gingipain proteases, hemagglutinins, and numerous other potential virulence factors that require further characterization. As an example, the secretion of P. gingivalis peptidylarginine deiminase (PPAD), which has been shown to neutralize human innate immune defenses, is exported via the T9SS. In addition, outer membrane vesicles (OMV) are increasingly recognized as effective long-distance vehicles of P. gingivalis virulence determinants to the external environment. Furthermore, OMVs have been shown to provide a novel delivery system for lipid A structures attached to the two lipopolysaccharides produced by this bacterium: O-LPS and A-LPS. Lipid A modifications by P. gingivalis represent a key patho-adaptation by modulating the host immuno-inflammatory response and providing protection from bacterial killing. Critically, it is also recognized that the full expression of the P. gingivalis keystone phenotype is strain-dependent and subject to environmental control, both of which may contribute to an individual's susceptibility to disease. These studies further validate and confirm the key contribution of P. gingivalis to the transition from periodontal health to disease.

Aim: To analyze the rate, timeline, and risk factors for furcation involvement (FI) progression using a large, multi-center electronic health record database.

Methods: This retrospective cohort study analyzed 3924 patients with periodontitis and at least 1 year of follow-up from the BigMouth Dental Data Repository. Furcation progression (increase in the maximum recorded furcation grade for a given tooth during the follow-up period) was assessed at both the patient and tooth level. Time-to-event analysis at the patient level was performed using Kaplan-Meier curves and a multivariate Cox Proportional Hazards model to identify predictive factors. At the tooth level, the primary analysis was a multilevel Cox model, with a Fine-Gray competing risks model performed as a secondary analysis to assess the impact of tooth loss.

Results: Over a mean follow-up of 4.7 years, 57.1% of patients experienced furcation progression, with a median time to the first event of 3.6 years. A Cox proportional hazards model identified smoking as the factor most strongly correlated with progression, increasing the risk by 51% (Hazard Ratio [HR]: 1.51), followed by high blood pressure (HR: 1.25) and diabetes (HR: 1.24). At the tooth level, the initial furcation grade showed the strongest association with progression, increasing the hazard by 3.05 times for each unit increase.

Conclusion: Furcation involvement is a progressive event for a majority of patients diagnosed with periodontitis. The risk of progression is correlated with a combination of systemic factors and the patient's overall periodontal status, but the factor most strongly correlated with a tooth's future deterioration is its own initial furcation grade.