Yiru Xia, Tinggang Chen, Yang Yang, Tung‐Liang Hsia, Zhikai Lin, Rong Shu, Lijun Luo, Dahong Qian, Yufeng Xie
Background Current radiographic evaluation of periodontal infrabony defects is subjective and prone to variability, limiting evidence‐based regenerative surgery planning. This study aimed to develop a dual‐model deep learning framework integrating YOLO V8 and nnU‐Net V2 to automate defect identification, quantification, and surgical guidance on parallel intraoral radiographs (PTRs). Methods A multicenter retrospective study utilized 580 PTRs from three institutions. The model combined YOLO V8 (tooth instance segmentation) and nnU‐Net V2 (tissue semantic segmentation) to localize anatomical landmarks, such as the cemento‐enamel junction (CEJ), lowest point of the defect (LP), alveolar crest (ALC), and root apex (APEX), and to calculate defect parameters (depth, width, angle). An internal dataset ( n = 387) derived from Shanghai Stomatological Hospital was used for model training and cross‐validation, while an external dataset ( n = 93) from two independent institutions (Shanghai Ninth People's Hospital and Tongji University) served for generalizability testing. The datasets were evaluated via 5‐fold cross‐validation. Performance metrics included Dice coefficient, mean absolute error (MAE), sensitivity, specificity, and F1‐score. Results The model achieved high precision in landmark localization (MAE: 0.20–0.54 mm) and strong generalizability, with external specificity of 0.96 and accuracy of 0.89. It outperformed specialists in diagnostic speed (1.5 vs. 2.1 min/patient) and accuracy (96% vs. 92%). Postoperative analysis demonstrated significant defect resolution. Defects were categorized via a color‐coded system (e.g., depth ≥3 mm recommended for regeneration), aligning with clinical guidelines. Conclusions This study pioneers a dual‐model AI framework for infrabony defect analysis, offering precise, guideline‐aligned surgical recommendations via a color‐coded system. By standardizing defect assessment and enhancing diagnostic efficiency, the model bridges radiographic interpretation and clinical decision‐making, advancing personalized periodontal care. Plain language summary A dual‐model AI framework combining YOLO V8 and nnU‐Net V2 accurately identifies and quantifies periodontal infrabony defects on radiographs, outperforming specialists in speed and diagnostic accuracy.
目前对牙周下骨缺损的x线评估是主观的，容易发生变化，限制了基于证据的再生手术计划。本研究旨在开发一个集成YOLO V8和nnU - Net V2的双模型深度学习框架，以自动识别、量化和并行口内x线片（PTRs）的手术指导。方法采用多中心回顾性研究方法，对来自3家机构的580例ptr进行分析。该模型结合YOLO V8（牙齿实例分割）和nnU - Net V2（组织语义分割）对牙骨质-牙釉质交界处（CEJ）、缺损最低点（LP）、牙槽嵴（ALC）和根尖（apex）等解剖标志进行定位，并计算缺损参数（深度、宽度、角度）。来自上海口腔医院的内部数据集（n = 387）用于模型训练和交叉验证，而来自两个独立机构（上海第九人民医院和同济大学）的外部数据集（n = 93）用于泛化检验。通过5倍交叉验证对数据集进行评估。性能指标包括Dice系数、平均绝对误差（MAE）、敏感性、特异性和F1评分。结果该模型具有较高的地标定位精度（MAE: 0.20 ~ 0.54 mm）和较强的通用性，外部特异性为0.96，准确度为0.89。它在诊断速度（1.5分钟对2.1分钟/患者）和准确性（96%对92%）方面优于专家。术后分析显示明显的缺陷解决。通过颜色编码系统对缺陷进行分类（例如，建议深度≥3mm进行再生），与临床指南保持一致。本研究开创了一种双模型人工智能框架，用于下骨缺损分析，通过颜色编码系统提供精确的、符合指南的手术建议。通过标准化的缺陷评估和提高诊断效率，该模型将放射学解释和临床决策联系起来，促进个性化牙周护理。结合YOLO V8和nnU - Net V2的双模型AI框架可以在x光片上准确识别和量化牙周下颌骨缺陷，在速度和诊断准确性方面优于专家。
{"title":"Deep learning‐based identification of periodontal infrabony defects with regenerative potential: A multicenter retrospective study","authors":"Yiru Xia, Tinggang Chen, Yang Yang, Tung‐Liang Hsia, Zhikai Lin, Rong Shu, Lijun Luo, Dahong Qian, Yufeng Xie","doi":"10.1002/jper.70039","DOIUrl":"https://doi.org/10.1002/jper.70039","url":null,"abstract":"Background Current radiographic evaluation of periodontal infrabony defects is subjective and prone to variability, limiting evidence‐based regenerative surgery planning. This study aimed to develop a dual‐model deep learning framework integrating YOLO V8 and nnU‐Net V2 to automate defect identification, quantification, and surgical guidance on parallel intraoral radiographs (PTRs). Methods A multicenter retrospective study utilized 580 PTRs from three institutions. The model combined YOLO V8 (tooth instance segmentation) and nnU‐Net V2 (tissue semantic segmentation) to localize anatomical landmarks, such as the cemento‐enamel junction (CEJ), lowest point of the defect (LP), alveolar crest (ALC), and root apex (APEX), and to calculate defect parameters (depth, width, angle). An internal dataset ( <jats:italic>n</jats:italic> = 387) derived from Shanghai Stomatological Hospital was used for model training and cross‐validation, while an external dataset ( <jats:italic>n</jats:italic> = 93) from two independent institutions (Shanghai Ninth People's Hospital and Tongji University) served for generalizability testing. The datasets were evaluated via 5‐fold cross‐validation. Performance metrics included Dice coefficient, mean absolute error (MAE), sensitivity, specificity, and F1‐score. Results The model achieved high precision in landmark localization (MAE: 0.20–0.54 mm) and strong generalizability, with external specificity of 0.96 and accuracy of 0.89. It outperformed specialists in diagnostic speed (1.5 vs. 2.1 min/patient) and accuracy (96% vs. 92%). Postoperative analysis demonstrated significant defect resolution. Defects were categorized via a color‐coded system (e.g., depth ≥3 mm recommended for regeneration), aligning with clinical guidelines. Conclusions This study pioneers a dual‐model AI framework for infrabony defect analysis, offering precise, guideline‐aligned surgical recommendations via a color‐coded system. By standardizing defect assessment and enhancing diagnostic efficiency, the model bridges radiographic interpretation and clinical decision‐making, advancing personalized periodontal care. Plain language summary A dual‐model AI framework combining YOLO V8 and nnU‐Net V2 accurately identifies and quantifies periodontal infrabony defects on radiographs, outperforming specialists in speed and diagnostic accuracy.","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"139 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145717496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marzieh S. Jazaeri, Danyal A. Siddiqui, Yi‐Wen C. Tsai, Kathryn Gabel, Zachary Lorenzana, Georgios A. Kotsakis
Background Current peri‐implantitis treatment methods are modeled after dental cleaning modalities like abrasive surface cleaning. However, mechanical abrasive cleaning not only inadequately removes implant biofilms but also compromises implant surface integrity with adverse biological effects. The goal of this study was to evaluate a non‐abrasive waterjet implant cleaning method to remove biofilm while preserving titanium surface and maintaining its cytocompatibility. Methods Dental plaque‐derived multispecies biofilms were cultured on acid‐etched titanium disks. Biofilm was removed using either mechanical contact abrasive implant cleaning (titanium brush or curette) or a non‐contact waterjet irrigator in continuous or pulsed flow setting. Uncontaminated and untreated disks served as negative and positive controls, respectively. Bacterial viability post‐treatment was assessed by agar plating and live‐dead imaging. Titanium surface integrity was studied by scanning electron microscopy and optical profilometry. Host tissue compatibility was evaluated by human gingival fibroblast proliferation on titanium surface post‐cleaning. Results Non‐contact waterjet irrigation significantly reduced viable bacterial counts by ≥90.9% (∼100‐fold) on titanium surface versus abrasively cleaned and untreated biofilm groups (all <jats:italic>p</jats:italic> < 0.05). Waterjet treatment maintained titanium surface integrity and roughness similar to pristine titanium. In contrast, abrasive cleaning damaged the microrough titanium surface and left viable bacterial residues. Fibroblast viability was restored (∼76.8%) on waterjet‐treated titanium to levels comparable to sterile control ( <jats:italic>p</jats:italic> > 0.05), whereas titanium brush‐ or curette‐treated surfaces had significantly lower levels post‐cleaning (all <jats:italic>p</jats:italic> < 0.05). Conclusions Non‐abrasive waterjet cleaning is a superior method for the clinical treatment of peri‐implantitis biofilms versus mechanical abrasive cleaning while maintaining titanium implant surface properties necessary for reintegration with peri‐implant tissue. Plain Language Summary Dental implant infections are usually cleaned by scrubbing the implant surface to remove attached bacteria. However, this mode of cleaning can scratch the implant surface and produce tiny pieces of wear or particles which can be toxic and cause the implant to fail. In this study, a new cleaning method using a fast‐flowing stream of water, called waterjet cleaning, was tested. The waterjet cleaning was able to remove most bacteria from the implant material, while cleaning by scrubbing left small spots of bacteria on the surface. Additionally, waterjet‐cleaned surfaces looked like the original implant material surface, while scrubbing‐cleaned surfaces had pieces missing from the surface, which affected human gum tissue cells attachment. Waterjet cleaning is a favorable method to clean dental implant infections without damagi
{"title":"Biofilm removal capacity and titanium surface integrity in non‐abrasive versus abrasive peri‐implantitis cleaning interventions","authors":"Marzieh S. Jazaeri, Danyal A. Siddiqui, Yi‐Wen C. Tsai, Kathryn Gabel, Zachary Lorenzana, Georgios A. Kotsakis","doi":"10.1002/jper.11371","DOIUrl":"https://doi.org/10.1002/jper.11371","url":null,"abstract":"Background Current peri‐implantitis treatment methods are modeled after dental cleaning modalities like abrasive surface cleaning. However, mechanical abrasive cleaning not only inadequately removes implant biofilms but also compromises implant surface integrity with adverse biological effects. The goal of this study was to evaluate a non‐abrasive waterjet implant cleaning method to remove biofilm while preserving titanium surface and maintaining its cytocompatibility. Methods Dental plaque‐derived multispecies biofilms were cultured on acid‐etched titanium disks. Biofilm was removed using either mechanical contact abrasive implant cleaning (titanium brush or curette) or a non‐contact waterjet irrigator in continuous or pulsed flow setting. Uncontaminated and untreated disks served as negative and positive controls, respectively. Bacterial viability post‐treatment was assessed by agar plating and live‐dead imaging. Titanium surface integrity was studied by scanning electron microscopy and optical profilometry. Host tissue compatibility was evaluated by human gingival fibroblast proliferation on titanium surface post‐cleaning. Results Non‐contact waterjet irrigation significantly reduced viable bacterial counts by ≥90.9% (∼100‐fold) on titanium surface versus abrasively cleaned and untreated biofilm groups (all <jats:italic>p</jats:italic> < 0.05). Waterjet treatment maintained titanium surface integrity and roughness similar to pristine titanium. In contrast, abrasive cleaning damaged the microrough titanium surface and left viable bacterial residues. Fibroblast viability was restored (∼76.8%) on waterjet‐treated titanium to levels comparable to sterile control ( <jats:italic>p</jats:italic> > 0.05), whereas titanium brush‐ or curette‐treated surfaces had significantly lower levels post‐cleaning (all <jats:italic>p</jats:italic> < 0.05). Conclusions Non‐abrasive waterjet cleaning is a superior method for the clinical treatment of peri‐implantitis biofilms versus mechanical abrasive cleaning while maintaining titanium implant surface properties necessary for reintegration with peri‐implant tissue. Plain Language Summary Dental implant infections are usually cleaned by scrubbing the implant surface to remove attached bacteria. However, this mode of cleaning can scratch the implant surface and produce tiny pieces of wear or particles which can be toxic and cause the implant to fail. In this study, a new cleaning method using a fast‐flowing stream of water, called waterjet cleaning, was tested. The waterjet cleaning was able to remove most bacteria from the implant material, while cleaning by scrubbing left small spots of bacteria on the surface. Additionally, waterjet‐cleaned surfaces looked like the original implant material surface, while scrubbing‐cleaned surfaces had pieces missing from the surface, which affected human gum tissue cells attachment. Waterjet cleaning is a favorable method to clean dental implant infections without damagi","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"4 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145717495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Previous studies concerning tooth loss and frailty risk primarily employed the number of teeth to categorize the extent of tooth loss. However, tooth loss is a dynamic process. Hence, this study aimed to identify the dynamic trajectories of tooth loss and analyze the relationship between tooth loss trajectories and frailty risk. Methods This analysis included 3355 participants enrolled in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The number of teeth and the frailty index were evaluated in 2008, 2011, 2014, and 2018, and the tooth loss trajectories were established using the group‐based trajectory model. The Cox model was used to analyze the relationship between tooth loss trajectories and frailty risk. Results Four tooth loss trajectories were identified, specifically the Persistently Mild Loss trajectory, the Progressively Severe Loss trajectory, the Persistently Moderate Loss trajectory, and the Edentulous trajectory. Compared with the Persistently Mild Loss trajectory, the Progressively Severe Loss trajectory (hazard ratio [HR] = 2.285, 95% confidence interval [CI]: 1.775–2.942), the Persistently Moderate Loss trajectory (HR = 1.215, 95%CI: 1.037–1.425), and the Edentulous trajectory (HR = 1.914, 95% CI: 1.481–2.475) were all related to higher frailty risk. Conclusion Older adults with the Progressively Severe Loss trajectory had a greater risk of frailty compared with those with the Persistently Mild Loss trajectory. This finding suggests that tooth loss could be used as a predictor for frailty and other diseases in future research. Plain Language Summary Previous studies on the link between tooth loss and frailty risk mainly focused on the number of teeth at 1 time point, ignoring that tooth loss is a dynamic process. Based on 4 waves of repeated measures of the number of teeth, this study identified 4 distinct trajectories of tooth loss. After adjustments, compared with the Persistently Mild Loss trajectory, the other 3, especially the Progressively Severe Loss trajectory, had a higher frailty risk. These findings thereby strengthen the evidence for the association between tooth loss and frailty risk, highlighting the importance of oral health protection and confirming tooth loss as a useful predictor of frailty. It should be noted that these findings are limited by data primarily coming from 1 ethnic group, Han (93.6%).
{"title":"Tooth loss trajectories and their association with frailty risk: A 10‐year population‐based cohort study","authors":"Kexin Zhang, Yulu Wang, Yuyang Zhang, Jiali Zheng, Yanwen Zhang, Yue Zhao, Qi Lu","doi":"10.1002/jper.70033","DOIUrl":"https://doi.org/10.1002/jper.70033","url":null,"abstract":"Background Previous studies concerning tooth loss and frailty risk primarily employed the number of teeth to categorize the extent of tooth loss. However, tooth loss is a dynamic process. Hence, this study aimed to identify the dynamic trajectories of tooth loss and analyze the relationship between tooth loss trajectories and frailty risk. Methods This analysis included 3355 participants enrolled in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The number of teeth and the frailty index were evaluated in 2008, 2011, 2014, and 2018, and the tooth loss trajectories were established using the group‐based trajectory model. The Cox model was used to analyze the relationship between tooth loss trajectories and frailty risk. Results Four tooth loss trajectories were identified, specifically the Persistently Mild Loss trajectory, the Progressively Severe Loss trajectory, the Persistently Moderate Loss trajectory, and the Edentulous trajectory. Compared with the Persistently Mild Loss trajectory, the Progressively Severe Loss trajectory (hazard ratio [HR] = 2.285, 95% confidence interval [CI]: 1.775–2.942), the Persistently Moderate Loss trajectory (HR = 1.215, 95%CI: 1.037–1.425), and the Edentulous trajectory (HR = 1.914, 95% CI: 1.481–2.475) were all related to higher frailty risk. Conclusion Older adults with the Progressively Severe Loss trajectory had a greater risk of frailty compared with those with the Persistently Mild Loss trajectory. This finding suggests that tooth loss could be used as a predictor for frailty and other diseases in future research. Plain Language Summary Previous studies on the link between tooth loss and frailty risk mainly focused on the number of teeth at 1 time point, ignoring that tooth loss is a dynamic process. Based on 4 waves of repeated measures of the number of teeth, this study identified 4 distinct trajectories of tooth loss. After adjustments, compared with the Persistently Mild Loss trajectory, the other 3, especially the Progressively Severe Loss trajectory, had a higher frailty risk. These findings thereby strengthen the evidence for the association between tooth loss and frailty risk, highlighting the importance of oral health protection and confirming tooth loss as a useful predictor of frailty. It should be noted that these findings are limited by data primarily coming from 1 ethnic group, Han (93.6%).","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"118 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145717468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The aim of this systematic review was to explore whether the benefits of biomaterials in periodontal regenerative/reconstructive surgery are affected by the type of flap employed. The study addresses the existing gap in the evidence to substantiate the beneficial effect of minimal invasive periodontal surgical approach compared to a conventional access flap (AF) surgery for the treatment of intrabony periodontal defects. Methods Electronic search on Embase, Medline, Cochrane, Scopus, and manual search were performed to identify suitable randomized controlled trials on periodontal regenerative/reconstructive surgery. The Cochrane Collaboration's tool was used to assess the risk of bias. Papers were divided according to flap design into AFs, papilla preservation flaps (PPFs), and single‐flap variants (SFVs). Meta‐analyses were carried out to assess the effect of the added biomaterial compared with controls on probing pocket depth (PPD) and clinical attachment level (CAL), subdivided by flap design. Results Of the 1311 papers initially identified, 523 underwent full‐text screening, and 29 publications representing 28 studies were ultimately included. In Group 1 (AFs, <jats:italic>n</jats:italic> = 6), the meta‐analysis revealed a statistically significant additional effect of biomaterials on improving CAL outcomes at 12 months, with an additional 2.46 mm CAL gain compared to control (95% confidence interval [CI]: 0.37–4.56, <jats:italic>p</jats:italic> = 0.02). In Group 2 (PPFs, <jats:italic>n</jats:italic> = 19), biomaterials provided a statistically significant benefit compared to PPF alone, with an additional 1.86 mm PPD reduction (95% CI: 0.29–3.42, <jats:italic>p</jats:italic> = 0.02) and 2.15 mm CAL gain (95% CI = 0.59–3.70, <jats:italic>p</jats:italic> = 0.01) at 12 months. In Group 3 (SFVs, <jats:italic>n</jats:italic> = 3), there was no statistically significant difference between the minimally invasive flap alone and its combination with biomaterials in terms of PPD reduction or CAL gain at 12 months. Conclusion This systematic review suggests that SFVs may reduce the need for biomaterials due to their minimally invasive nature. The limited number of studies included in the SFV group and the high heterogeneity represent limitations of this review. It is still unclear whether flap design alone or the addition of biomaterials has a greater impact on clinical outcomes such as PPD reduction and CAL gain. The relative importance of biomaterials in periodontal regeneration requires further investigation. Plain language summary This study reviewed existing clinical trials to understand whether the way gum tissue is lifted during surgery—known as flap design—affects the need for added materials (biomaterials) when treating bone loss caused by gum disease. Biomaterials are often used to support healing in regenerative periodontal surgery. However, newer surgical techniques that involve smaller trauma may reduce the need for these materia
本系统综述的目的是探讨生物材料在牙周再生/重建手术中的益处是否受到使用的皮瓣类型的影响。该研究解决了现有证据的空白，以证实微创牙周手术入路与传统的通道皮瓣（AF）手术治疗骨内牙周缺损的有益效果。方法采用Embase、Medline、Cochrane、Scopus等电子检索和人工检索方法，筛选适合牙周再生/重建手术的随机对照试验。Cochrane协作的工具被用来评估偏倚风险。根据皮瓣设计将论文分为AFs、乳头保存皮瓣（PPFs）和单皮瓣变体（SFVs）。通过Meta分析评估添加的生物材料与对照组相比对探查袋深度（PPD）和临床附着水平（CAL）的影响，并按皮瓣设计细分。在最初确定的1311篇论文中，523篇进行了全文筛选，最终纳入了29篇代表28项研究的出版物。在第1组（AFs, n = 6）中，meta分析显示生物材料在12个月时对改善CAL结果有统计学显著的额外作用，与对照组相比，CAL增加了2.46 mm（95%置信区间[CI]: 0.37-4.56, p = 0.02）。在第二组（PPF, n = 19）中，与单独使用PPF相比，生物材料提供了统计学上显著的益处，12个月时PPD减少1.86 mm (95% CI: 0.29-3.42, p = 0.02)， CAL增加2.15 mm （95% CI = 0.59-3.70, p = 0.01）。在第3组（SFVs, n = 3）中，单独微创皮瓣与联合生物材料在12个月时PPD减少或CAL增加方面无统计学差异。结论该系统综述表明sfv由于其微创性可能减少对生物材料的需求。纳入SFV组的研究数量有限，异质性高，这表明了本综述的局限性。目前尚不清楚是单独设计皮瓣还是添加生物材料对临床结果（如PPD降低和CAL增加）有更大的影响。生物材料在牙周再生中的相对重要性有待进一步研究。本研究回顾了现有的临床试验，以了解手术中牙龈组织的提升方式（称为皮瓣设计）是否会影响治疗牙龈疾病引起的骨质流失时对添加材料（生物材料）的需求。在再生牙周手术中，生物材料常用于支持愈合。然而，涉及较小创伤的新手术技术可能会减少对这些材料的需求。该综述将研究分为三种类型的皮瓣设计：传统的通道皮瓣、乳头保存皮瓣和单瓣变异（一种微创技术）。研究发现，与传统皮瓣或保留乳头的皮瓣联合使用生物材料可改善预后。相比之下，当生物材料添加到单瓣变异时，没有观察到明显的益处。这些发现表明，通过一定的微创技术，即使没有生物材料，也可以实现有效的愈合。然而，只有少数研究检查了单瓣变异，并且不同研究的结果不同，这意味着需要更多的研究。了解什么时候真正需要生物材料可以帮助降低治疗成本，改善愈合，并指导晚期牙龈疾病患者更好的手术选择。
{"title":"The influence of flap design on the relevance of biomaterials in regenerative periodontal surgery","authors":"Payvand Menhadji, Neha Kansagra, Luigi Nibali","doi":"10.1002/jper.70034","DOIUrl":"https://doi.org/10.1002/jper.70034","url":null,"abstract":"Background The aim of this systematic review was to explore whether the benefits of biomaterials in periodontal regenerative/reconstructive surgery are affected by the type of flap employed. The study addresses the existing gap in the evidence to substantiate the beneficial effect of minimal invasive periodontal surgical approach compared to a conventional access flap (AF) surgery for the treatment of intrabony periodontal defects. Methods Electronic search on Embase, Medline, Cochrane, Scopus, and manual search were performed to identify suitable randomized controlled trials on periodontal regenerative/reconstructive surgery. The Cochrane Collaboration's tool was used to assess the risk of bias. Papers were divided according to flap design into AFs, papilla preservation flaps (PPFs), and single‐flap variants (SFVs). Meta‐analyses were carried out to assess the effect of the added biomaterial compared with controls on probing pocket depth (PPD) and clinical attachment level (CAL), subdivided by flap design. Results Of the 1311 papers initially identified, 523 underwent full‐text screening, and 29 publications representing 28 studies were ultimately included. In Group 1 (AFs, <jats:italic>n</jats:italic> = 6), the meta‐analysis revealed a statistically significant additional effect of biomaterials on improving CAL outcomes at 12 months, with an additional 2.46 mm CAL gain compared to control (95% confidence interval [CI]: 0.37–4.56, <jats:italic>p</jats:italic> = 0.02). In Group 2 (PPFs, <jats:italic>n</jats:italic> = 19), biomaterials provided a statistically significant benefit compared to PPF alone, with an additional 1.86 mm PPD reduction (95% CI: 0.29–3.42, <jats:italic>p</jats:italic> = 0.02) and 2.15 mm CAL gain (95% CI = 0.59–3.70, <jats:italic>p</jats:italic> = 0.01) at 12 months. In Group 3 (SFVs, <jats:italic>n</jats:italic> = 3), there was no statistically significant difference between the minimally invasive flap alone and its combination with biomaterials in terms of PPD reduction or CAL gain at 12 months. Conclusion This systematic review suggests that SFVs may reduce the need for biomaterials due to their minimally invasive nature. The limited number of studies included in the SFV group and the high heterogeneity represent limitations of this review. It is still unclear whether flap design alone or the addition of biomaterials has a greater impact on clinical outcomes such as PPD reduction and CAL gain. The relative importance of biomaterials in periodontal regeneration requires further investigation. Plain language summary This study reviewed existing clinical trials to understand whether the way gum tissue is lifted during surgery—known as flap design—affects the need for added materials (biomaterials) when treating bone loss caused by gum disease. Biomaterials are often used to support healing in regenerative periodontal surgery. However, newer surgical techniques that involve smaller trauma may reduce the need for these materia","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"38 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145717497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Limited awareness, clinical barriers, and persistent high prevalence make large‐scale detection of periodontitis challenging, creating demand for simple, affordable, and population‐level screening strategies outside traditional dental settings. This study evaluates the diagnostic performance of self‐test activated matrix metalloproteinase‐8 (aMMP‐8) for identifying periodontitis and assesses the feasibility of a fully self‐reported screening model compared with models based on quantitative aMMP‐8 point‐of‐care test (POCT) results. Methods In this cross‐sectional diagnostic study, we evaluated the diagnostic performance of three index tests: self‐performed or POCT aMMP‐8 alone on an oral rinse sample, or in combination with a questionnaire. Periodontitis status was determined using radiographic bone loss according to the 2017 classification, as stages III–IV or stages II–IV. Binary logistic regression models were developed using least absolute shrinkage and selection operator regularization and 5‐fold cross‐validation. Model performance was assessed by area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and accuracy. Results A total of 566 participants were included, and 41.7% were diagnosed with stages II–IV periodontitis. Both self‐test and quantitative aMMP‐8 results were significantly associated with periodontitis. In univariable models, self‐test aMMP‐8 showed lower AUROC than quantitative results. However, adding questionnaires and demographic factors in multivariable models improved the diagnostic performance of self‐test and minimized the gap between the two. The final multivariable models showed comparable performance for self‐test aMMP‐8‐based (AUROC = 0.955) and quantitative aMMP‐8‐based (AUROC = 0.957) models in stages III–IV periodontitis prediction, with similar results for stages II–IV periodontitis. Conclusion This study showed that a self‐test aMMP‐8‐based multivariable diagnostic model can perform similarly to a quantitative aMMP‐8 POCT‐based one. Once further developed and validated, a fully self‐reported diagnostic model can provide a potential tool for periodontitis screening. Plain language summary This study examined whether a simple, self‐administered mouth rinse test could aid in identifying individuals with advanced gum disease. Over 550 adults participated, and approximately 42% were found to have severe gum disease. We discovered that the self‐test alone was less accurate than a more detailed machine‐based quantitative reading. However, when combined with a questionnaire about dental health and basic personal information, the accuracy of detection improved a lot. These combined methods performed well and were similar to using only the machine results. Our results suggest that a simple screening approach, which includes a self‐test, a questionnaire, and personal details, could be an inexpensive and easy‐to‐use tool for community health screenings to identify severe gum dis
{"title":"aMMP‐8 self‐testing and self‐administered questionnaires for periodontitis screening: A diagnostic trial in a Chinese population","authors":"Yu Xie, Xiaoyu Yu, Mengning Bi, Hairui Li, Yuan Li, Maurizio S. Tonetti","doi":"10.1002/jper.70032","DOIUrl":"https://doi.org/10.1002/jper.70032","url":null,"abstract":"Background Limited awareness, clinical barriers, and persistent high prevalence make large‐scale detection of periodontitis challenging, creating demand for simple, affordable, and population‐level screening strategies outside traditional dental settings. This study evaluates the diagnostic performance of self‐test activated matrix metalloproteinase‐8 (aMMP‐8) for identifying periodontitis and assesses the feasibility of a fully self‐reported screening model compared with models based on quantitative aMMP‐8 point‐of‐care test (POCT) results. Methods In this cross‐sectional diagnostic study, we evaluated the diagnostic performance of three index tests: self‐performed or POCT aMMP‐8 alone on an oral rinse sample, or in combination with a questionnaire. Periodontitis status was determined using radiographic bone loss according to the 2017 classification, as stages III–IV or stages II–IV. Binary logistic regression models were developed using least absolute shrinkage and selection operator regularization and 5‐fold cross‐validation. Model performance was assessed by area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and accuracy. Results A total of 566 participants were included, and 41.7% were diagnosed with stages II–IV periodontitis. Both self‐test and quantitative aMMP‐8 results were significantly associated with periodontitis. In univariable models, self‐test aMMP‐8 showed lower AUROC than quantitative results. However, adding questionnaires and demographic factors in multivariable models improved the diagnostic performance of self‐test and minimized the gap between the two. The final multivariable models showed comparable performance for self‐test aMMP‐8‐based (AUROC = 0.955) and quantitative aMMP‐8‐based (AUROC = 0.957) models in stages III–IV periodontitis prediction, with similar results for stages II–IV periodontitis. Conclusion This study showed that a self‐test aMMP‐8‐based multivariable diagnostic model can perform similarly to a quantitative aMMP‐8 POCT‐based one. Once further developed and validated, a fully self‐reported diagnostic model can provide a potential tool for periodontitis screening. Plain language summary This study examined whether a simple, self‐administered mouth rinse test could aid in identifying individuals with advanced gum disease. Over 550 adults participated, and approximately 42% were found to have severe gum disease. We discovered that the self‐test alone was less accurate than a more detailed machine‐based quantitative reading. However, when combined with a questionnaire about dental health and basic personal information, the accuracy of detection improved a lot. These combined methods performed well and were similar to using only the machine results. Our results suggest that a simple screening approach, which includes a self‐test, a questionnaire, and personal details, could be an inexpensive and easy‐to‐use tool for community health screenings to identify severe gum dis","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"1 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145717499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The aim of this study is to explore how neutrophil extracellular traps (NETs) and phosphatidylserine exposure contribute to hypercoagulability in periodontitis with type 2 diabetes (T2D). Methods Ninety‐six participants were divided into groups with periodontitis (CP), T2D, periodontitis with type 2 diabetes (DP), and a healthy control (CTR). Coagulation profiles were assessed using coagulation time and fibrin generation tests. Confocal microscopy and flow cytometry measured phosphatidylserine (PS)‐exposed cells and NETs in blood samples. The impact of NETs on endothelial cells was evaluated through Western blot, confocal microscopy, and angiogenesis tests. We evaluated the NETs levels in patients before and after treatment through blood glucose control or periodontitis treatment. Results DP patients showed shorter coagulation times, higher fibrinogen levels, and more blood cells (e.g., platelets and neutrophils) with PS exposure, along with increased NETs release. Activated platelets were found to stimulate NETs release more than microparticle‐poor plasma. NETs damage vascular endothelial cells, leading to increased vascular cell adhesion molecule‐1 (VCAM‐1), decreased vascular endothelial cadherin (VE‐cadherin), actin reorganization, reduced tube formation, and higher procoagulant activity in endothelial cells. After periodontal treatment or blood sugar control, the levels of NETs decreased significantly in patients with DP. Conclusions In patients with DP, activated platelets trigger neutrophils to release excess NETs, which create a pro‐thrombotic state by damaging endothelial cells. Small‐scale clinical trials underscore the value of controlling local infection and hyperglycemia as first‐line “NET‐modulating” strategies. Plain Language Summary The hypercoagulability of DP patient can be partially explained by the activated platelet‐promoted excess NETs providing a scaffold for clotting factors, damaging endothelial cells intercellular connections, converting of endothelial cells to pro‐coagulant phenotype, and impairing of endothelial cells tube formation capacity. Blood sugar control and periodontal treatment can regulate the levels of NETs which represents the generation of new promising DP treatment options. In the future, efforts should be made to develop therapeutic strategies targeting NETs or PS.
{"title":"Neutrophil extracellular traps and phosphatidylserine exposure: The hidden thrombotic threat of periodontitis with diabetes","authors":"Mengdi Li, Hongyu Kuang, Xiaoming Wu, Lina He, Yanping Li, Shuang Pan, Valerie A. Novakovic, Huimei Liu, Jialan Shi, Yumei Niu","doi":"10.1002/jper.70038","DOIUrl":"https://doi.org/10.1002/jper.70038","url":null,"abstract":"Background The aim of this study is to explore how neutrophil extracellular traps (NETs) and phosphatidylserine exposure contribute to hypercoagulability in periodontitis with type 2 diabetes (T2D). Methods Ninety‐six participants were divided into groups with periodontitis (CP), T2D, periodontitis with type 2 diabetes (DP), and a healthy control (CTR). Coagulation profiles were assessed using coagulation time and fibrin generation tests. Confocal microscopy and flow cytometry measured phosphatidylserine (PS)‐exposed cells and NETs in blood samples. The impact of NETs on endothelial cells was evaluated through Western blot, confocal microscopy, and angiogenesis tests. We evaluated the NETs levels in patients before and after treatment through blood glucose control or periodontitis treatment. Results DP patients showed shorter coagulation times, higher fibrinogen levels, and more blood cells (e.g., platelets and neutrophils) with PS exposure, along with increased NETs release. Activated platelets were found to stimulate NETs release more than microparticle‐poor plasma. NETs damage vascular endothelial cells, leading to increased vascular cell adhesion molecule‐1 (VCAM‐1), decreased vascular endothelial cadherin (VE‐cadherin), actin reorganization, reduced tube formation, and higher procoagulant activity in endothelial cells. After periodontal treatment or blood sugar control, the levels of NETs decreased significantly in patients with DP. Conclusions In patients with DP, activated platelets trigger neutrophils to release excess NETs, which create a pro‐thrombotic state by damaging endothelial cells. Small‐scale clinical trials underscore the value of controlling local infection and hyperglycemia as first‐line “NET‐modulating” strategies. Plain Language Summary The hypercoagulability of DP patient can be partially explained by the activated platelet‐promoted excess NETs providing a scaffold for clotting factors, damaging endothelial cells intercellular connections, converting of endothelial cells to pro‐coagulant phenotype, and impairing of endothelial cells tube formation capacity. Blood sugar control and periodontal treatment can regulate the levels of NETs which represents the generation of new promising DP treatment options. In the future, efforts should be made to develop therapeutic strategies targeting NETs or PS.","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"26 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145717500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Emerging evidence supports a bidirectional link between periodontitis and inflammatory bowel disease (IBD). To investigate this relationship, experimental models commonly use dextran sodium sulfate (DSS) to induce colitis. However, DSS is presumed to selectively affect the colon, and its potential off‐target effects on the oral cavity remain poorly understood. We examined whether DSS disrupts oral health, potentially confounding oral–gut axis research. Methods C57BL/6 mice received 2% DSS in drinking water for 8 days, followed by 2 days of untreated water. Colitis severity was assessed by weight loss, colon length, histopathology, and quantitative real‐time–polymerase chain reaction (qRT‐PCR). Oral health was evaluated via micro–computed tomography (micro‐CT) analysis of alveolar bone, gingival histology, cytokine expression, and 16S rRNA sequencing of the oral microbiome. Results DSS induced hallmark features of colitis, including weight loss, colon shortening, epithelial crypt damage, and mucosal inflammation. Strikingly, DSS also induced significant oral pathology, including alveolar bone loss, gingival epithelial hyperplasia, inflammatory infiltration, and upregulated gingival pro‐inflammatory cytokines (interleukin [IL] ‐6, IL‐17, tumor necrosis factor‐alpha [TNF‐α]). DSS further altered the oral microbiota causing reduced alpha‐diversity and a dysbiotic shift, with enrichment of Streptococcus danieliae and depletion of commensals such as Lactobacillus murinus and Clostridium ASF502 . These microbial changes were accompanied by upregulated pathways involved in carbohydrate metabolism, oxidative stress response, and environmental sensing. Conclusion DSS induces periodontal inflammation and oral dysbiosis, independent of colitis. These findings expose a critical confounder in oral–gut axis models and highlight the need to include DSS‐only or periodontitis‐only controls and alternative models to accurately distinguish systemic effects of DSS from true oral–gut interactions. Plain language summary This study shows that dextran sodium sulfate (DSS), a chemical used to model gut inflammation in mice, also causes gum disease‐like changes—including bone loss, inflammation, and changes in oral bacteria. These findings reveal that DSS alone can affect the mouth and may confound studies investigating links between gum disease and inflammatory bowel disease, highlighting the need for better‐controlled models.
{"title":"Dextran sodium sulfate confounds causal role of periodontitis in inflammatory bowel disease","authors":"Himanshi Tanwar, Jeba Mercy Gnanasekaran, Niyant Ganesh, Cindy Zhou, Amy Plotkin, Giacomo Baima, Massimo Costalonga, Fenfen Zhou, Hanping Feng, Priyam Jani, Jean‐Pierre Raufman, Vivek Thumbigere‐Math","doi":"10.1002/jper.70045","DOIUrl":"https://doi.org/10.1002/jper.70045","url":null,"abstract":"Background Emerging evidence supports a bidirectional link between periodontitis and inflammatory bowel disease (IBD). To investigate this relationship, experimental models commonly use dextran sodium sulfate (DSS) to induce colitis. However, DSS is presumed to selectively affect the colon, and its potential off‐target effects on the oral cavity remain poorly understood. We examined whether DSS disrupts oral health, potentially confounding oral–gut axis research. Methods C57BL/6 mice received 2% DSS in drinking water for 8 days, followed by 2 days of untreated water. Colitis severity was assessed by weight loss, colon length, histopathology, and quantitative real‐time–polymerase chain reaction (qRT‐PCR). Oral health was evaluated via micro–computed tomography (micro‐CT) analysis of alveolar bone, gingival histology, cytokine expression, and 16S rRNA sequencing of the oral microbiome. Results DSS induced hallmark features of colitis, including weight loss, colon shortening, epithelial crypt damage, and mucosal inflammation. Strikingly, DSS also induced significant oral pathology, including alveolar bone loss, gingival epithelial hyperplasia, inflammatory infiltration, and upregulated gingival pro‐inflammatory cytokines (interleukin [IL] ‐6, IL‐17, tumor necrosis factor‐alpha [TNF‐α]). DSS further altered the oral microbiota causing reduced alpha‐diversity and a dysbiotic shift, with enrichment of <jats:italic>Streptococcus danieliae</jats:italic> and depletion of commensals such as <jats:italic>Lactobacillus murinus</jats:italic> and <jats:italic>Clostridium ASF502</jats:italic> . These microbial changes were accompanied by upregulated pathways involved in carbohydrate metabolism, oxidative stress response, and environmental sensing. Conclusion DSS induces periodontal inflammation and oral dysbiosis, independent of colitis. These findings expose a critical confounder in oral–gut axis models and highlight the need to include DSS‐only or periodontitis‐only controls and alternative models to accurately distinguish systemic effects of DSS from true oral–gut interactions. Plain language summary This study shows that dextran sodium sulfate (DSS), a chemical used to model gut inflammation in mice, also causes gum disease‐like changes—including bone loss, inflammation, and changes in oral bacteria. These findings reveal that DSS alone can affect the mouth and may confound studies investigating links between gum disease and inflammatory bowel disease, highlighting the need for better‐controlled models.","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"135 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145704198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christina Zachariadou,Anuja Doshi,Dimitris N Tatakis,Brian L Foster
BACKGROUNDEpithelium is the periodontal first line of defense against microbes. Discoidin domain receptor 1 (DDR1) is a collagen receptor expressed in epithelium. Ddr1 knockout (Ddr1-/-) mice develop periodontitis-like defects, including junctional epithelium (JE) downgrowth, bacterial invasion, and alveolar bone loss. The objective of this study was to investigate epithelial responses in the absence of DDR1. We hypothesized that Ddr1-/- mice exhibit increased JE permeability and delayed epithelial wound healing.METHODSEpithelium was analyzed in Ddr1-/- and wild-type (Ddr1+/+) mice. JE permeability was studied in vivo by applying a fluorescent dye and measuring dye penetration. Immunohistochemistry (IHC) was used to identify the localization of E-cadherin and collagens IV, VIII, and XVII in oral epithelium. DDR1 expression in wound healing was confirmed by histology. Epithelial wound healing responses were assessed by creating skin and oral wounds and measuring epithelial migration and wound closure.RESULTSNo differences in JE permeability were observed between Ddr1-/- and Ddr1+/+ mice, although a trend in the means was observed toward decreased dye surface area (p = 0.07) and intensity (p = 0.08-0.09) in the periodontium of the former mice. IHC did not reveal differences in the localization of E-cadherin or collagens IV, VIII, and XVII between genotypes. In human gingiva, DDR1 was expressed at the epithelial front, migrating to cover palatal wounds. Wound healing experiments revealed a higher % wound healing of dorsal skin in Ddr1-/- than Ddr1+/+ mice at 5 days post-wounding (dpw) (p = 0.01).CONCLUSIONSDDR1 does not affect JE permeability but may play a role in effective epithelial cell migration during cutaneous wound healing.PLAIN LANGUAGE SUMMARYEpithelium is the periodontal first line of defense against microbial attacks. Discoidin domain receptor 1 (DDR1) is a collagen receptor expressed at the epithelium. Mice not expressing the receptor (Ddr1-/- mice) develop defects consistent with periodontitis, including epithelium downgrowth and bone loss. In this study, we investigated periodontal epithelial permeability by applying a fluorescent dye in the mouth of Ddr1+/+ and Ddr1-/- mice. Additionally, we used histological methods to reveal differences in the localization of gingival proteins between Ddr1+/+ and Ddr1-/-. Finally, we investigated the role of DDR1 in wound healing in human sections and in a live animal model. No differences in junctional epithelium (JE) permeability were observed between Ddr1+/+ and Ddr1-/- mice, as expressed by the comparable presence of dye in the periodontal tissues of both types of mice. There were no differences in the localization of E-cadherin or collagens IV, VIII, and XVII between Ddr1+/+ and Ddr1-/-. In human gingiva, DDR1 was expressed at the epithelial front, migrating to cover palatal wounds. The animal wound healing study revealed higher healing of skin wounds in Ddr1-/- than Ddr1+/+ mice at 5 dpw. In
{"title":"Evaluation of Discoidin domain receptor 1 (DDR1) in junctional epithelial permeability and wound healing.","authors":"Christina Zachariadou,Anuja Doshi,Dimitris N Tatakis,Brian L Foster","doi":"10.1002/jper.70031","DOIUrl":"https://doi.org/10.1002/jper.70031","url":null,"abstract":"BACKGROUNDEpithelium is the periodontal first line of defense against microbes. Discoidin domain receptor 1 (DDR1) is a collagen receptor expressed in epithelium. Ddr1 knockout (Ddr1-/-) mice develop periodontitis-like defects, including junctional epithelium (JE) downgrowth, bacterial invasion, and alveolar bone loss. The objective of this study was to investigate epithelial responses in the absence of DDR1. We hypothesized that Ddr1-/- mice exhibit increased JE permeability and delayed epithelial wound healing.METHODSEpithelium was analyzed in Ddr1-/- and wild-type (Ddr1+/+) mice. JE permeability was studied in vivo by applying a fluorescent dye and measuring dye penetration. Immunohistochemistry (IHC) was used to identify the localization of E-cadherin and collagens IV, VIII, and XVII in oral epithelium. DDR1 expression in wound healing was confirmed by histology. Epithelial wound healing responses were assessed by creating skin and oral wounds and measuring epithelial migration and wound closure.RESULTSNo differences in JE permeability were observed between Ddr1-/- and Ddr1+/+ mice, although a trend in the means was observed toward decreased dye surface area (p = 0.07) and intensity (p = 0.08-0.09) in the periodontium of the former mice. IHC did not reveal differences in the localization of E-cadherin or collagens IV, VIII, and XVII between genotypes. In human gingiva, DDR1 was expressed at the epithelial front, migrating to cover palatal wounds. Wound healing experiments revealed a higher % wound healing of dorsal skin in Ddr1-/- than Ddr1+/+ mice at 5 days post-wounding (dpw) (p = 0.01).CONCLUSIONSDDR1 does not affect JE permeability but may play a role in effective epithelial cell migration during cutaneous wound healing.PLAIN LANGUAGE SUMMARYEpithelium is the periodontal first line of defense against microbial attacks. Discoidin domain receptor 1 (DDR1) is a collagen receptor expressed at the epithelium. Mice not expressing the receptor (Ddr1-/- mice) develop defects consistent with periodontitis, including epithelium downgrowth and bone loss. In this study, we investigated periodontal epithelial permeability by applying a fluorescent dye in the mouth of Ddr1+/+ and Ddr1-/- mice. Additionally, we used histological methods to reveal differences in the localization of gingival proteins between Ddr1+/+ and Ddr1-/-. Finally, we investigated the role of DDR1 in wound healing in human sections and in a live animal model. No differences in junctional epithelium (JE) permeability were observed between Ddr1+/+ and Ddr1-/- mice, as expressed by the comparable presence of dye in the periodontal tissues of both types of mice. There were no differences in the localization of E-cadherin or collagens IV, VIII, and XVII between Ddr1+/+ and Ddr1-/-. In human gingiva, DDR1 was expressed at the epithelial front, migrating to cover palatal wounds. The animal wound healing study revealed higher healing of skin wounds in Ddr1-/- than Ddr1+/+ mice at 5 dpw. In ","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"21 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145656974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Timothy Treat, Dylan Jones, Natalie Lorenzano, Scott Umberfield, Andrew Bartels, Titus Schleyer, Heather Taylor
Background Evidence for whether and how non‐surgical periodontal treatment (NSPT) improves systemic outcomes remains equivocal. Inconclusive findings may in part be due to design variations of randomized controlled trials (RCTs) in this field. The objective of this study was to describe the study design characteristics of RCTs that have evaluated the effect of non‐surgical periodontal treatment on systemic health outcomes. Methods We searched Medline via Ovid and EMBASE for RCTs published through January 1, 2024, for terms indicating NSPT (i.e., scaling and root planing) and selected chronic diseases. We developed a standardized coding sheet for systematically extracting data from studies, including the definition of periodontal disease (PD) among study participants, the length of study duration, and whether the effect of NSPT was found to have a statistically significant beneficial, detrimental, or null effect on systemic outcomes. Results Eighty‐two RCTs, which reported the effect of NSPT on systemic outcomes in 816 individual analyses, met our inclusion criteria. Fifty‐six studies (68.3%) had at least 1 of 4 variations in study design that may contribute to biased results. Studies that restricted their inclusion criteria to participants with severe PD were more likely to measure a beneficial effect than a non‐beneficial effect on specific systemic outcomes following NSPT (62.7% vs. 49.2%, p < 0.001). Conclusion Variation in study designs of RCTs may be contributing to mixed and inconclusive findings investigating the effect of NSPT on systemic disease outcomes. Plain Language Summary This study reviewed clinical trials to understand why the evidence on whether non‐surgical periodontal treatment (NSPT) can improve overall health is inconclusive. Eighty‐two clinical trials were analyzed to identify patterns in how these studies were designed. While most trials found that NSPT had some benefits, more than two‐thirds of the studies had design features that could skew results. Trials involving participants with severe gum disease were more likely to show benefits than those including people with milder forms. How clinical trials are set up—such as who is included and how long the study lasts—may heavily affect overall findings. The study highlights the need for more standardized approaches to research in this area to better understand whether and how dental treatments can improve overall health. These findings are important for designing future studies and ensuring reliable evidence for medical and dental professionals.
{"title":"Design characteristics of studies evaluating the effect of non‐surgical periodontal treatment on systemic health outcomes","authors":"Timothy Treat, Dylan Jones, Natalie Lorenzano, Scott Umberfield, Andrew Bartels, Titus Schleyer, Heather Taylor","doi":"10.1002/jper.24-0847","DOIUrl":"https://doi.org/10.1002/jper.24-0847","url":null,"abstract":"Background Evidence for whether and how non‐surgical periodontal treatment (NSPT) improves systemic outcomes remains equivocal. Inconclusive findings may in part be due to design variations of randomized controlled trials (RCTs) in this field. The objective of this study was to describe the study design characteristics of RCTs that have evaluated the effect of non‐surgical periodontal treatment on systemic health outcomes. Methods We searched Medline via Ovid and EMBASE for RCTs published through January 1, 2024, for terms indicating NSPT (i.e., scaling and root planing) and selected chronic diseases. We developed a standardized coding sheet for systematically extracting data from studies, including the definition of periodontal disease (PD) among study participants, the length of study duration, and whether the effect of NSPT was found to have a statistically significant beneficial, detrimental, or null effect on systemic outcomes. Results Eighty‐two RCTs, which reported the effect of NSPT on systemic outcomes in 816 individual analyses, met our inclusion criteria. Fifty‐six studies (68.3%) had at least 1 of 4 variations in study design that may contribute to biased results. Studies that restricted their inclusion criteria to participants with severe PD were more likely to measure a beneficial effect than a non‐beneficial effect on specific systemic outcomes following NSPT (62.7% vs. 49.2%, <jats:italic>p</jats:italic> < 0.001). Conclusion Variation in study designs of RCTs may be contributing to mixed and inconclusive findings investigating the effect of NSPT on systemic disease outcomes. Plain Language Summary This study reviewed clinical trials to understand why the evidence on whether non‐surgical periodontal treatment (NSPT) can improve overall health is inconclusive. Eighty‐two clinical trials were analyzed to identify patterns in how these studies were designed. While most trials found that NSPT had some benefits, more than two‐thirds of the studies had design features that could skew results. Trials involving participants with severe gum disease were more likely to show benefits than those including people with milder forms. How clinical trials are set up—such as who is included and how long the study lasts—may heavily affect overall findings. The study highlights the need for more standardized approaches to research in this area to better understand whether and how dental treatments can improve overall health. These findings are important for designing future studies and ensuring reliable evidence for medical and dental professionals.","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"165 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145554453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background The potential of hydrogen sulfide (H 2 S) gas as a biomarker for periodontitis has been suggested, but the evidence remains inconclusive. This preliminary study aimed to explore the relationship between periodontitis, defined according to the 2018 classification by the American Academy of Periodontology and the European Federation of Periodontology and exhaled H 2 S gas in the Thai population. Methods In 2023, a cross‐sectional study was conducted involving 172 systemically healthy, non‐smoking individuals aged 18 years or older who were included from three healthcare centers, Chiang Mai, Thailand. Participants underwent interviews, oral and periodontal examinations, and exhaled H 2 S gas detection using an innovative LTCC‐GASSET device. H 2 S levels and periodontal status were analyzed statistically. Results H 2 S levels significantly increased in groups with periodontitis compared to those without, with the magnitude of the increase corresponding to the stage of periodontitis. This trend was particularly pronounced in the older group (≥41 years). Moderate positive linear correlations were observed between H 2 S levels and clinical periodontal parameters, with the strongest correlation found for clinical attachment loss (CAL). Multiple regression analysis confirmed significant associations between H 2 S levels, CAL, and periodontal probing depth, after adjusting for confounders. Additionally, a threshold of 177.5 ppb for H 2 S levels was found to differentiate severe periodontitis, with AUC, sensitivity, and specificity of 0.733, 0.722, and 0.720, respectively. Conclusions Exhaled H 2 S levels were associated with periodontitis severity in non‐smoking, systemically healthy individuals. Given its limitations, the LTCC‐GASSET device may have potential for non‐invasive detection of periodontitis. Plain Language Summary This study examined the association between periodontitis, diagnosed using the 2018 AAP/EFP classification, and exhaled hydrogen sulfide (H 2 S) levels in 172 non‐smoking, systemically healthy adults. H 2 S levels were measured with the LTCC‐GASSET device, revealing higher levels in individuals with periodontitis, especially in more severe cases. Older participants (aged ≥41 years) had higher H 2 S levels, particularly if they had periodontitis. The H 2 S cut‐off level appeared to help distinguish between severe and non‐severe periodontitis cases. Within the limitations of a cross‐sectional study, these findings suggest that H 2 S levels could be useful for identifying individuals at higher risk for periodontal disease.
{"title":"Association between periodontitis severity and exhaled hydrogen sulfide measured using LTCC‐GASSET device in healthy Thai patients","authors":"Chanyanuch Wechwithayakhlung, Matawee Punginsang, Kanittha Inyawilert, Kata Jaruwongrungsee, Anurat Wisitsoraat, Siriporn Chattipakorn, Chaikarn Liewhiran, Teerat Sawangpanyangkura","doi":"10.1002/jper.70025","DOIUrl":"https://doi.org/10.1002/jper.70025","url":null,"abstract":"Background The potential of hydrogen sulfide (H <jats:sub>2</jats:sub> S) gas as a biomarker for periodontitis has been suggested, but the evidence remains inconclusive. This preliminary study aimed to explore the relationship between periodontitis, defined according to the 2018 classification by the American Academy of Periodontology and the European Federation of Periodontology and exhaled H <jats:sub>2</jats:sub> S gas in the Thai population. Methods In 2023, a cross‐sectional study was conducted involving 172 systemically healthy, non‐smoking individuals aged 18 years or older who were included from three healthcare centers, Chiang Mai, Thailand. Participants underwent interviews, oral and periodontal examinations, and exhaled H <jats:sub>2</jats:sub> S gas detection using an innovative LTCC‐GASSET device. H <jats:sub>2</jats:sub> S levels and periodontal status were analyzed statistically. Results H <jats:sub>2</jats:sub> S levels significantly increased in groups with periodontitis compared to those without, with the magnitude of the increase corresponding to the stage of periodontitis. This trend was particularly pronounced in the older group (≥41 years). Moderate positive linear correlations were observed between H <jats:sub>2</jats:sub> S levels and clinical periodontal parameters, with the strongest correlation found for clinical attachment loss (CAL). Multiple regression analysis confirmed significant associations between H <jats:sub>2</jats:sub> S levels, CAL, and periodontal probing depth, after adjusting for confounders. Additionally, a threshold of 177.5 ppb for H <jats:sub>2</jats:sub> S levels was found to differentiate severe periodontitis, with AUC, sensitivity, and specificity of 0.733, 0.722, and 0.720, respectively. Conclusions Exhaled H <jats:sub>2</jats:sub> S levels were associated with periodontitis severity in non‐smoking, systemically healthy individuals. Given its limitations, the LTCC‐GASSET device may have potential for non‐invasive detection of periodontitis. Plain Language Summary This study examined the association between periodontitis, diagnosed using the 2018 AAP/EFP classification, and exhaled hydrogen sulfide (H <jats:sub>2</jats:sub> S) levels in 172 non‐smoking, systemically healthy adults. H <jats:sub>2</jats:sub> S levels were measured with the LTCC‐GASSET device, revealing higher levels in individuals with periodontitis, especially in more severe cases. Older participants (aged ≥41 years) had higher H <jats:sub>2</jats:sub> S levels, particularly if they had periodontitis. The H <jats:sub>2</jats:sub> S cut‐off level appeared to help distinguish between severe and non‐severe periodontitis cases. Within the limitations of a cross‐sectional study, these findings suggest that H <jats:sub>2</jats:sub> S levels could be useful for identifying individuals at higher risk for periodontal disease.","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"93 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145535254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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