BACKGROUNDThis study evaluated the diagnostic accuracy of visual assessment of mucosal transparency using a standard periodontal probe (VAT) to differentiate between thin and thick peri-implant mucosal phenotypes, compared to horizontal transmucosal probing (HTP). A secondary objective was to assess facial mucosal thickness (FMT) threshold values for peri-implant mucosa phenotype classification.METHODSAdult subjects with at least one non-molar single implant-supported prosthesis (ISP) were screened. To evaluate VAT, a standard periodontal probe was inserted through the peri-implant sulcus on the midfacial aspect. FMT was measured via HTP using an endodontic spreader.RESULTSA total of 247 subjects and 281 ISPs constituted the study population. Setting a 2 mm threshold, 66.2% of sites were classified as thick and 33.8% as thin. Compared to HTP, VAT demonstrated a sensitivity (SE) of 12.6%, a specificity (SP) of 96.2%, a positive predictive value (PPV) of 63%, and a negative predictive value (NPV) of 66%. At the 1.5 mm threshold, 86.1% of sites were thick and 13.9% thin, with 25.6% SE, 96.3% SP, 53% PPV, and 89% NPV. At the 1 mm threshold, 92.2% of sites were thick and 7.8% thin, with 41% SE, 96% SP, 47% PPV, and 95% NPV. Receiver operating characteristic analysis revealed the best-fitting balance for PPV (58%) and NPV (91%) at an FMT of 1.25 mm.CONCLUSIONSRegardless of the FMT threshold applied, VAT demonstrated limited diagnostic accuracy, in particular for thin phenotypes, proving unreliable for the dichotomic characterization of thin and thick peri-implant mucosal phenotypes. This study was approved by the ethical committee for clinical studies in the canton of Bern, Switzerland (KEK-BE-No. 2023-01962).
{"title":"Diagnostic accuracy of transmucosal probe visualization for peri-implant mucosal phenotype assessment: A cross-sectional study.","authors":"Emilio Couso-Queiruga,Manrique Fonseca,Diogo Moreira Rodrigues,Gustavo Avila-Ortiz,Vivianne Chappuis,Clemens Raabe","doi":"10.1002/jper.70062","DOIUrl":"https://doi.org/10.1002/jper.70062","url":null,"abstract":"BACKGROUNDThis study evaluated the diagnostic accuracy of visual assessment of mucosal transparency using a standard periodontal probe (VAT) to differentiate between thin and thick peri-implant mucosal phenotypes, compared to horizontal transmucosal probing (HTP). A secondary objective was to assess facial mucosal thickness (FMT) threshold values for peri-implant mucosa phenotype classification.METHODSAdult subjects with at least one non-molar single implant-supported prosthesis (ISP) were screened. To evaluate VAT, a standard periodontal probe was inserted through the peri-implant sulcus on the midfacial aspect. FMT was measured via HTP using an endodontic spreader.RESULTSA total of 247 subjects and 281 ISPs constituted the study population. Setting a 2 mm threshold, 66.2% of sites were classified as thick and 33.8% as thin. Compared to HTP, VAT demonstrated a sensitivity (SE) of 12.6%, a specificity (SP) of 96.2%, a positive predictive value (PPV) of 63%, and a negative predictive value (NPV) of 66%. At the 1.5 mm threshold, 86.1% of sites were thick and 13.9% thin, with 25.6% SE, 96.3% SP, 53% PPV, and 89% NPV. At the 1 mm threshold, 92.2% of sites were thick and 7.8% thin, with 41% SE, 96% SP, 47% PPV, and 95% NPV. Receiver operating characteristic analysis revealed the best-fitting balance for PPV (58%) and NPV (91%) at an FMT of 1.25 mm.CONCLUSIONSRegardless of the FMT threshold applied, VAT demonstrated limited diagnostic accuracy, in particular for thin phenotypes, proving unreliable for the dichotomic characterization of thin and thick peri-implant mucosal phenotypes. This study was approved by the ethical committee for clinical studies in the canton of Bern, Switzerland (KEK-BE-No. 2023-01962).","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"42 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044640","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}
Lorenzo Tavelli,Birtan Yilmaz,Lara Steiner Back,François Vigouroux,Po-Jan Kuo,Edward Tseng,Shayan Barootchi
Over the past several decades, periodontal plastic surgery has undergone a remarkable transformation, particularly in the field of root coverage procedures. This review traces the historical evolution of surgical techniques, from the early use of pedicle flaps and free gingival grafts (FGGs) to the development of bilaminar approaches incorporating subepithelial connective tissue grafts (SCTGs). Each stage of innovation has contributed to improved predictability and enhanced esthetic outcomes, while also aiming to reduce patient morbidity. The introduction and continuous evolution of the coronally advanced flap (CAF) marked a significant advancement, progressively improving the consistency and predictability of complete root coverage. Later developments, such as tunneling techniques (TUNs), emphasized minimally invasive flap preparation, preservation of vascular supply, and improved esthetics. These principles were ultimately combined in approaches such as the tunneled coronally advanced flap (TCAF), a versatile technique that merges the strengths of both CAF and TUN, with the focus on the specific features of the site and its local anatomy. This review also highlights how clinical insights, surgical refinements, and biologic understanding have shaped modern flap designs, graft handling, and treatment planning. With the growing demand for esthetic outcomes and individualized care, future directions in root coverage surgery are expected to include further refinement of flap designs, integration of injectable biologics and biomaterials, and the implementation of patient- and site-specific protocols. By revisiting the historical foundations and innovations that have defined root coverage surgery, this review underscores the importance of technique selection and customization in achieving optimal clinical outcomes. PLAIN LANGUAGE SUMMARY: Over the years, gum surgery for covering gingival recessions has improved significantly. This review looks at how techniques have evolved-from early methods to more advanced ones using a connective tissue graft obtained from the roof of the mouth. These innovations have made results more reliable, more natural-looking, and easier on patients. A major step forward was the so-called "coronally advanced flap (CAF)," which improved how well and consistently roots could be covered. Later, "tunneling techniques (TUNs)" were introduced to be less invasive and to better preserve blood supply. Eventually, these ideas were combined in a newer approach called the "tunneled coronally advanced flap (TCAF)," which adapts to the specific shape and needs of each treatment site. This review highlights the key modifications and innovations proposed over the years that have shaped the development of various surgical approaches for root coverage.
{"title":"Tracing the evolution of root coverage: Clinical milestones leading to a minimally invasive era.","authors":"Lorenzo Tavelli,Birtan Yilmaz,Lara Steiner Back,François Vigouroux,Po-Jan Kuo,Edward Tseng,Shayan Barootchi","doi":"10.1002/jper.70044","DOIUrl":"https://doi.org/10.1002/jper.70044","url":null,"abstract":"Over the past several decades, periodontal plastic surgery has undergone a remarkable transformation, particularly in the field of root coverage procedures. This review traces the historical evolution of surgical techniques, from the early use of pedicle flaps and free gingival grafts (FGGs) to the development of bilaminar approaches incorporating subepithelial connective tissue grafts (SCTGs). Each stage of innovation has contributed to improved predictability and enhanced esthetic outcomes, while also aiming to reduce patient morbidity. The introduction and continuous evolution of the coronally advanced flap (CAF) marked a significant advancement, progressively improving the consistency and predictability of complete root coverage. Later developments, such as tunneling techniques (TUNs), emphasized minimally invasive flap preparation, preservation of vascular supply, and improved esthetics. These principles were ultimately combined in approaches such as the tunneled coronally advanced flap (TCAF), a versatile technique that merges the strengths of both CAF and TUN, with the focus on the specific features of the site and its local anatomy. This review also highlights how clinical insights, surgical refinements, and biologic understanding have shaped modern flap designs, graft handling, and treatment planning. With the growing demand for esthetic outcomes and individualized care, future directions in root coverage surgery are expected to include further refinement of flap designs, integration of injectable biologics and biomaterials, and the implementation of patient- and site-specific protocols. By revisiting the historical foundations and innovations that have defined root coverage surgery, this review underscores the importance of technique selection and customization in achieving optimal clinical outcomes. PLAIN LANGUAGE SUMMARY: Over the years, gum surgery for covering gingival recessions has improved significantly. This review looks at how techniques have evolved-from early methods to more advanced ones using a connective tissue graft obtained from the roof of the mouth. These innovations have made results more reliable, more natural-looking, and easier on patients. A major step forward was the so-called \"coronally advanced flap (CAF),\" which improved how well and consistently roots could be covered. Later, \"tunneling techniques (TUNs)\" were introduced to be less invasive and to better preserve blood supply. Eventually, these ideas were combined in a newer approach called the \"tunneled coronally advanced flap (TCAF),\" which adapts to the specific shape and needs of each treatment site. This review highlights the key modifications and innovations proposed over the years that have shaped the development of various surgical approaches for root coverage.","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"50 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044635","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}
Yu-Ting Yeh,Vincent Li,Caroline Chen,Hsuan-Hung Chen,Guo-Hao Lin,Richard T Kao,Effie Ioannidou
BACKGROUNDThis retrospective study aimed to evaluate the influence of the implant platform apico-coronal position on the crestal bone level of adjacent teeth, focusing on the anterior and premolar regions.METHODSNinety-six patients with 117 implants were included. The vertical distance from the implant platform to the crestal bone level of adjacent teeth was measured, and bone level changes were assessed from loading to the last follow-up. The implant position was categorized into two subgroups based on the vertical distance (≤2 or > 2 mm). Associations between vertical distance, bone loss on adjacent teeth and implants, and other variables were analyzed using linear regression and multivariate generalized estimating equations (GEE).RESULTSLinear regression showed a significant association between implant vertical distance and bone loss on adjacent teeth, but not at implant sites. Multivariate GEE analysis revealed that a vertical distance of > 2 mm, a convex prosthesis emergence profile, and female sex were significantly associated with a greater bone loss on adjacent teeth. After adjusting for sex, implants with a vertical distance of > 2 mm combined with a convex profile presented greater bone loss compared with a concave profile. In contrast, when the vertical distance was ≤2 mm, no statistically significant difference was found between implants with convex or concave profiles.CONCLUSIONAn implant positioned more than 2 mm vertically relative to the crestal bone level of the adjacent teeth was associated with a greater crestal bone loss on these teeth. This suggests that clinicians should carefully consider vertical implant positioning to prevent bone loss around the adjacent teeth.PLAIN LANGUAGE SUMMARYThis study looked at how the vertical position of a dental implant affects the bone levels around nearby natural teeth, especially in the front and premolar areas of the mouth. Our team reviewed records from 96 patients who received a total of 117 implants. We measured the distance between the top of each implant and the bone level of the teeth next to it. The implants were grouped into two categories: those placed 2 millimeters or less below the bone level of nearby teeth, and those placed more than 2 millimeters below. The results showed that when implants were placed more than 2 millimeters below the nearby teeth, there was more bone loss around those natural teeth over time. This was especially true when the implant crown had a rounded (convex) shape at the gumline and in female patients. However, when the implant was placed closer to the bone level (≤2 mm) of the adjacent teeth, the amount of bone loss was smaller and less affected by the crown shape. Dentists should carefully consider how deep they place implants in relation to the surrounding teeth. Placing implants too far apical of the bone level of nearby teeth may lead to unwanted bone loss in those teeth, especially if the implant crown has a rounded (convex) profile. Proper implan
{"title":"The influence of implant platform apico-coronal position on the bone level of adjacent teeth.","authors":"Yu-Ting Yeh,Vincent Li,Caroline Chen,Hsuan-Hung Chen,Guo-Hao Lin,Richard T Kao,Effie Ioannidou","doi":"10.1002/jper.70056","DOIUrl":"https://doi.org/10.1002/jper.70056","url":null,"abstract":"BACKGROUNDThis retrospective study aimed to evaluate the influence of the implant platform apico-coronal position on the crestal bone level of adjacent teeth, focusing on the anterior and premolar regions.METHODSNinety-six patients with 117 implants were included. The vertical distance from the implant platform to the crestal bone level of adjacent teeth was measured, and bone level changes were assessed from loading to the last follow-up. The implant position was categorized into two subgroups based on the vertical distance (≤2 or > 2 mm). Associations between vertical distance, bone loss on adjacent teeth and implants, and other variables were analyzed using linear regression and multivariate generalized estimating equations (GEE).RESULTSLinear regression showed a significant association between implant vertical distance and bone loss on adjacent teeth, but not at implant sites. Multivariate GEE analysis revealed that a vertical distance of > 2 mm, a convex prosthesis emergence profile, and female sex were significantly associated with a greater bone loss on adjacent teeth. After adjusting for sex, implants with a vertical distance of > 2 mm combined with a convex profile presented greater bone loss compared with a concave profile. In contrast, when the vertical distance was ≤2 mm, no statistically significant difference was found between implants with convex or concave profiles.CONCLUSIONAn implant positioned more than 2 mm vertically relative to the crestal bone level of the adjacent teeth was associated with a greater crestal bone loss on these teeth. This suggests that clinicians should carefully consider vertical implant positioning to prevent bone loss around the adjacent teeth.PLAIN LANGUAGE SUMMARYThis study looked at how the vertical position of a dental implant affects the bone levels around nearby natural teeth, especially in the front and premolar areas of the mouth. Our team reviewed records from 96 patients who received a total of 117 implants. We measured the distance between the top of each implant and the bone level of the teeth next to it. The implants were grouped into two categories: those placed 2 millimeters or less below the bone level of nearby teeth, and those placed more than 2 millimeters below. The results showed that when implants were placed more than 2 millimeters below the nearby teeth, there was more bone loss around those natural teeth over time. This was especially true when the implant crown had a rounded (convex) shape at the gumline and in female patients. However, when the implant was placed closer to the bone level (≤2 mm) of the adjacent teeth, the amount of bone loss was smaller and less affected by the crown shape. Dentists should carefully consider how deep they place implants in relation to the surrounding teeth. Placing implants too far apical of the bone level of nearby teeth may lead to unwanted bone loss in those teeth, especially if the implant crown has a rounded (convex) profile. Proper implan","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"274 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044637","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}
BACKGROUNDInsulin resistance, a key risk factor in type 2 diabetes contributes to the initiation and progression of periodontitis. Although several studies have reported associations between non-insulin-based insulin resistance indices and periodontitis in the general population, these associations have not been investigated in patients with diabetes, who may benefit more from the clinical application of such indices.METHODSThis study analyzed data from 64,971 adults from the Korea National Health and Nutrition Examination Survey (2010-2018). Associations between non-insulin-based insulin resistance indices, including triglyceride/high-density lipoprotein cholesterol (TG/HDL), the metabolic score for insulin resistance (METS_IR), triglyceride glucose index (TyG), TyG indices adjusted for body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), and periodontitis were assessed. Associations and diagnostic accuracy were evaluated using ordinal logistic regression and receiver operating characteristic (ROC) analyses.RESULTSOrdinal logistic regression revealed that METS_IR had the strongest association with periodontitis (odds ratio [OR] = 1.401). In the group with poorly controlled diabetes (HbA1c ≥ 7.0%), all insulin resistance indices had higher ORs when compared with the group with well-controlled diabetes, with METS_IR showing the highest OR in both groups. ROC analysis revealed that TyG*WHtR had the highest diagnostic accuracy (area under the curve [AUC] = 0.6719).CONCLUSIONAmong patients with diabetes, METS_IR was the most strongly associated with periodontitis, and TyG*WHtR exhibited the highest diagnostic accuracy. These indices may be useful tools for the early identification of high-risk periodontitis in patients with diabetes.PLAIN LANGUAGE SUMMARYTo our knowledge, this is the first comprehensive evaluation of the association between multiple blood test-derived insulin resistance indices and periodontitis in patients with diabetes. The analysis identified metabolic score for insulin resistance (METS_IR) and triglyceride glucose index*waist-to-height ratio (TyG*WHtR) as the indices with the closest association with periodontitis and the highest diagnostic accuracy, respectively. These indices were closely linked to the risk of periodontitis in patients with diabetes, and TyG*WHtR was the most effective predictor. These simple blood test indices may allow early-stage periodontal health risk assessment and management in patients with diabetes.
{"title":"Insulin resistance indices and periodontitis in patients with diabetes: A nationwide population-based study.","authors":"Yuri Kim,Ji-Eun Kim,Ki-Ho Chung","doi":"10.1002/jper.70059","DOIUrl":"https://doi.org/10.1002/jper.70059","url":null,"abstract":"BACKGROUNDInsulin resistance, a key risk factor in type 2 diabetes contributes to the initiation and progression of periodontitis. Although several studies have reported associations between non-insulin-based insulin resistance indices and periodontitis in the general population, these associations have not been investigated in patients with diabetes, who may benefit more from the clinical application of such indices.METHODSThis study analyzed data from 64,971 adults from the Korea National Health and Nutrition Examination Survey (2010-2018). Associations between non-insulin-based insulin resistance indices, including triglyceride/high-density lipoprotein cholesterol (TG/HDL), the metabolic score for insulin resistance (METS_IR), triglyceride glucose index (TyG), TyG indices adjusted for body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR), and periodontitis were assessed. Associations and diagnostic accuracy were evaluated using ordinal logistic regression and receiver operating characteristic (ROC) analyses.RESULTSOrdinal logistic regression revealed that METS_IR had the strongest association with periodontitis (odds ratio [OR] = 1.401). In the group with poorly controlled diabetes (HbA1c ≥ 7.0%), all insulin resistance indices had higher ORs when compared with the group with well-controlled diabetes, with METS_IR showing the highest OR in both groups. ROC analysis revealed that TyG*WHtR had the highest diagnostic accuracy (area under the curve [AUC] = 0.6719).CONCLUSIONAmong patients with diabetes, METS_IR was the most strongly associated with periodontitis, and TyG*WHtR exhibited the highest diagnostic accuracy. These indices may be useful tools for the early identification of high-risk periodontitis in patients with diabetes.PLAIN LANGUAGE SUMMARYTo our knowledge, this is the first comprehensive evaluation of the association between multiple blood test-derived insulin resistance indices and periodontitis in patients with diabetes. The analysis identified metabolic score for insulin resistance (METS_IR) and triglyceride glucose index*waist-to-height ratio (TyG*WHtR) as the indices with the closest association with periodontitis and the highest diagnostic accuracy, respectively. These indices were closely linked to the risk of periodontitis in patients with diabetes, and TyG*WHtR was the most effective predictor. These simple blood test indices may allow early-stage periodontal health risk assessment and management in patients with diabetes.","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"100 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044636","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}
BACKGROUNDThis study investigates the impact of disruptions in testosterone levels on bone remodeling, root resorption, and periodontal ligament (PDL) during orthodontic tooth movement (OTM) in a pubertal male rat model.METHODSTestosterone deficiency was induced through orchiectomy, and the anabolic-androgenic steroid (AAS, testosterone undecanoate) was administered in both replacement and high doses. OTM was simulated using a closed-coil spring on the maxillary right first molar. The surrounding tissues-alveolar bone and periodontal ligament-of both the moved tooth and the contralateral (control) tooth were analyzed 5 and 10 days post-OTM using micro-CT, reverse-transcription quantitative polymerase chain reaction (RT-qPCR), and immunohistochemistry. Root resorption, testosterone, and adrenocorticotropic hormone plasmatic levels were also evaluated.RESULTSBoth testosterone deficiency and high-dose AAS lead to significant changes in bone microarchitecture, resulting in reduced trabecular thickness, decreased bone connectivity, and bone lacunae. Testosterone dysfunction was associated with greater rotation and intrusion of the moved tooth. High-dose AAS intensified the inflammatory infiltrate and root resorption. Moreover, testosterone dysfunction altered the expression of key genes involved in bone metabolism, including Runx2, Bmp2, Spp1, and Bglap. The Rank/Rankl/Opg pathway was also deregulated due to testosterone disturbances. AAS at replacement doses did not normalize the inflammatory infiltrate, OTM, and the expression of the studied genes to control levels.CONCLUSIONSTestosterone dysfunction whether from deficiency or high-dose AAS exposure negatively impacts OTM, increasing bone resorption and promoting inflammation, potentially leading to long-term consequences for bone health and periodontal support. AAS at replacement doses may also impact PDL and bone during OTM.
{"title":"Effects of testosterone and high-dose anabolic steroids on orthodontic-induced bone remodeling and root resorption: An animal study.","authors":"Caio Luiz Bitencourt Reis,Kelly Galisteu-Luiz,Gabriela Leite Pedroso,Gustavo Lopes Puls,Leticia Cassaro,Bruno Boaventura Vieira,Fábio Lourenço Romano,Erika Calvano Küchler,Christian Kirschneck,Daniela Silva Barroso de Oliveira,Maria Bernadete Sasso Stuani,Mirian Aiko Nakane Matsumoto","doi":"10.1002/jper.70068","DOIUrl":"https://doi.org/10.1002/jper.70068","url":null,"abstract":"BACKGROUNDThis study investigates the impact of disruptions in testosterone levels on bone remodeling, root resorption, and periodontal ligament (PDL) during orthodontic tooth movement (OTM) in a pubertal male rat model.METHODSTestosterone deficiency was induced through orchiectomy, and the anabolic-androgenic steroid (AAS, testosterone undecanoate) was administered in both replacement and high doses. OTM was simulated using a closed-coil spring on the maxillary right first molar. The surrounding tissues-alveolar bone and periodontal ligament-of both the moved tooth and the contralateral (control) tooth were analyzed 5 and 10 days post-OTM using micro-CT, reverse-transcription quantitative polymerase chain reaction (RT-qPCR), and immunohistochemistry. Root resorption, testosterone, and adrenocorticotropic hormone plasmatic levels were also evaluated.RESULTSBoth testosterone deficiency and high-dose AAS lead to significant changes in bone microarchitecture, resulting in reduced trabecular thickness, decreased bone connectivity, and bone lacunae. Testosterone dysfunction was associated with greater rotation and intrusion of the moved tooth. High-dose AAS intensified the inflammatory infiltrate and root resorption. Moreover, testosterone dysfunction altered the expression of key genes involved in bone metabolism, including Runx2, Bmp2, Spp1, and Bglap. The Rank/Rankl/Opg pathway was also deregulated due to testosterone disturbances. AAS at replacement doses did not normalize the inflammatory infiltrate, OTM, and the expression of the studied genes to control levels.CONCLUSIONSTestosterone dysfunction whether from deficiency or high-dose AAS exposure negatively impacts OTM, increasing bone resorption and promoting inflammation, potentially leading to long-term consequences for bone health and periodontal support. AAS at replacement doses may also impact PDL and bone during OTM.","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"102 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044639","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}
Kedith Sawangsri,Aonjittra Phanrungsuwan,Binnaz Leblebicioglu,José Luis Millán,Brian L Foster
BACKGROUNDAlveolar bone loss challenges tooth retention and implant placement. Freeze-dried bone allograft (FDBA) is widely used for alveolar ridge preservation but has limitations in resorption rate and healing time. In this proof-of-concept study, we tested whether pro-mineralization enzyme, tissue-nonspecific alkaline phosphatase (TNAP) enhances bone healing.METHODSSeven-week-old mice (n = 4-6/group; equal numbers of males and females) underwent maxillary molar extraction and standardized alveolar defect creation. Mice were assigned to sham, FDBA with saline (BGS) or FDBA with mineral-targeted TNAP-Fc-D10 (BGT). Healing was assessed using microcomputed tomography (micro-CT), serum alkaline phosphatase (ALP) levels, histology, and immunohistochemistry, between 14- and 60-days post-procedure (dpp). Intergroup comparisons were analyzed by one-way ANOVA and post-hoc Tukey test (α = 0.05) RESULTS: At 14 dpp, the BGT group demonstrated significantly greater bone volume fraction (BV/TV) and bone mineral density (BMD) compared with BGS (p < 0.01, p < 0.05) and sham groups (p < 0.001). Alveolar bone volume was greater than sham (p < 0.001). Alveolar bone dimension (height and width) was significantly more stable in the BGT group (p < 0.05). Although BV/TV at 60 dpp showed no significant differences, BGT maintained higher BMD and alveolar bone width stability (p < 0.01). Histological and immunohistochemical analyses revealed increased new bone formation and greater bone marker expression in the short-term BGT group (p < 0.05). No changes in serum ALP levels were detected.CONCLUSIONSTNAP-Fc-D10 with FDBA significantly enhances early alveolar bone healing and dimensional stability. While long-term volumetric gains were not observed, sustained improvements in mineral density and ridge preservation support TNAP as a promising biologic for alveolar ridge preservation.PLAIN LANGUAGE SUMMARYWhen people lose teeth, keeping enough bone in the jaw is critical for future treatments like dental implants. A common material used to rebuild bone is called freeze-dried bone allograft (FDBA), but it does not always heal quickly or completely. In this study, we tested whether adding a special enzyme called TNAP, which helps build bones naturally, could make FDBA work better. After extracting teeth and creating bone defects in mice, we compared healing between three groups: control (sham), FDBA + saline, and FDBA + engineered TNAP-Fc-D10. After 2 weeks, the group that received FDBA+TNAP-Fc-D10 showed more new bone formation and better preservation of the size of the jawbone. Even after 2 months, their bone remained denser and more stable compared with the other groups. Importantly, we found no signs of unwanted side effects in the blood. These results suggest that adding TNAP-Fc-D10 could make bone grafts more effective early on, helping preserve jaw structure better over time. More research is needed to fine-tune the treatment and see how well it works in humans.
{"title":"Mineral-targeted alkaline phosphatase improves bone graft-mediated alveolar bone defect healing in mice.","authors":"Kedith Sawangsri,Aonjittra Phanrungsuwan,Binnaz Leblebicioglu,José Luis Millán,Brian L Foster","doi":"10.1002/jper.70061","DOIUrl":"https://doi.org/10.1002/jper.70061","url":null,"abstract":"BACKGROUNDAlveolar bone loss challenges tooth retention and implant placement. Freeze-dried bone allograft (FDBA) is widely used for alveolar ridge preservation but has limitations in resorption rate and healing time. In this proof-of-concept study, we tested whether pro-mineralization enzyme, tissue-nonspecific alkaline phosphatase (TNAP) enhances bone healing.METHODSSeven-week-old mice (n = 4-6/group; equal numbers of males and females) underwent maxillary molar extraction and standardized alveolar defect creation. Mice were assigned to sham, FDBA with saline (BGS) or FDBA with mineral-targeted TNAP-Fc-D10 (BGT). Healing was assessed using microcomputed tomography (micro-CT), serum alkaline phosphatase (ALP) levels, histology, and immunohistochemistry, between 14- and 60-days post-procedure (dpp). Intergroup comparisons were analyzed by one-way ANOVA and post-hoc Tukey test (α = 0.05) RESULTS: At 14 dpp, the BGT group demonstrated significantly greater bone volume fraction (BV/TV) and bone mineral density (BMD) compared with BGS (p < 0.01, p < 0.05) and sham groups (p < 0.001). Alveolar bone volume was greater than sham (p < 0.001). Alveolar bone dimension (height and width) was significantly more stable in the BGT group (p < 0.05). Although BV/TV at 60 dpp showed no significant differences, BGT maintained higher BMD and alveolar bone width stability (p < 0.01). Histological and immunohistochemical analyses revealed increased new bone formation and greater bone marker expression in the short-term BGT group (p < 0.05). No changes in serum ALP levels were detected.CONCLUSIONSTNAP-Fc-D10 with FDBA significantly enhances early alveolar bone healing and dimensional stability. While long-term volumetric gains were not observed, sustained improvements in mineral density and ridge preservation support TNAP as a promising biologic for alveolar ridge preservation.PLAIN LANGUAGE SUMMARYWhen people lose teeth, keeping enough bone in the jaw is critical for future treatments like dental implants. A common material used to rebuild bone is called freeze-dried bone allograft (FDBA), but it does not always heal quickly or completely. In this study, we tested whether adding a special enzyme called TNAP, which helps build bones naturally, could make FDBA work better. After extracting teeth and creating bone defects in mice, we compared healing between three groups: control (sham), FDBA + saline, and FDBA + engineered TNAP-Fc-D10. After 2 weeks, the group that received FDBA+TNAP-Fc-D10 showed more new bone formation and better preservation of the size of the jawbone. Even after 2 months, their bone remained denser and more stable compared with the other groups. Importantly, we found no signs of unwanted side effects in the blood. These results suggest that adding TNAP-Fc-D10 could make bone grafts more effective early on, helping preserve jaw structure better over time. More research is needed to fine-tune the treatment and see how well it works in humans.","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"16 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044638","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 To evaluate the change in clinical tooth mobility following scaling and root planing (SRP) and to identify baseline factors predictive of the 12‐month outcome. Methods This retrospective cohort study utilized de‐identified electronic health records from the BigMouth Dental Data Repository. The final cohort consisted of 152 patients, contributing 489 teeth with baseline mobility of Class 1, 2, or 3. The primary outcome was the change in mobility class at 12 months. A multilevel cumulative link model (ordinal logistic regression) was used to determine the association between baseline factors (including splinting status) and the 12‐month mobility outcome. Results Scaling and root planing resulted in a substantial reduction in tooth mobility. At 12 months, 71.2% of teeth with initial Class 1 mobility and 42.2% of teeth with initial Class 2 mobility became clinically stable (Class 0). The multilevel regression analysis identified several factors significantly associated with higher odds of a less favorable outcome: higher initial mobility, deeper probing depths, furcation involvement, smoking, and diabetes ( p < 0.05). The presence of a splint/stabilization was significantly associated with higher odds of a more favorable mobility outcome (OR = 2.15, p < 0.01). Conclusions Within the limitations of this retrospective study, SRP appears effective in reducing tooth mobility within 1 year. The identified predictors can help clinicians to manage patient's expectations and to highlight cases that may require more intensive therapy or monitoring. Plain language summary Severe gum disease can cause teeth to become loose, putting them at risk of being lost. This study investigated whether a common “deep cleaning” procedure (non‐surgical periodontal therapy) could help to stabilize these loose teeth. We analyzed the de‐identified dental records of 152 patients from eight U.S. university clinics, tracking the outcomes of 489 loose teeth for 1 year after treatment. Our results showed that the deep cleaning was very successful. Most teeth, even those that were moderately or severely loose, became significantly firmer. For example, more than 70% of slightly loose teeth became completely stable again. We also identified factors that made a successful outcome less likely, including smoking, diabetes, having more severe gum disease, or having a very loose tooth to begin with. This research provides evidence that this routine therapy is effective in tightening loose teeth, which can help dentists and patients to make better‐informed decisions about saving teeth and maintaining oral health.
研究背景：评估刮治和牙根刨平（SRP）后临床牙齿活动度的变化，并确定预测12个月结果的基线因素。方法：本回顾性队列研究利用来自BigMouth牙科数据存储库的电子健康记录。最后的队列包括152名患者，489颗牙齿的基线活动度为1级、2级或3级。主要结果是12个月时活动能力等级的变化。采用多层次累积联系模型（有序逻辑回归）来确定基线因素（包括夹板状态）与12个月活动能力结果之间的关系。结果刮治和牙根刨平可显著降低牙齿的活动度。12个月时，71.2%的初始1级活动度牙齿和42.2%的初始2级活动度牙齿临床稳定（0级）。多水平回归分析确定了几个与较差结果的高概率显著相关的因素：较高的初始活动性、更深的探查深度、分叉受损伤、吸烟和糖尿病（p < 0.05）。夹板/稳定装置的存在与更有利的活动结果的更高几率显著相关（OR = 2.15, p < 0.01）。结论：在本回顾性研究的局限性内，SRP在1年内有效地降低了牙齿的活动度。确定的预测因素可以帮助临床医生管理患者的期望，并突出可能需要更多强化治疗或监测的病例。严重的牙龈疾病会导致牙齿松动，使它们有脱落的危险。这项研究调查了一种常见的“深度清洁”程序（非手术牙周治疗）是否有助于稳定这些松动的牙齿。我们分析了来自美国8所大学诊所的152名患者的牙科记录，追踪了489颗松动牙齿治疗后1年的结果。我们的结果表明，深层清洁是非常成功的。大多数牙齿，甚至是那些中度或严重松动的牙齿，都变得明显更紧实了。例如，超过70%的轻微松动的牙齿又完全稳定了。我们还发现了一些不太可能成功的因素，包括吸烟、糖尿病、更严重的牙龈疾病，或者一开始就有一颗非常松动的牙齿。这项研究提供了证据，证明这种常规疗法对收紧松动的牙齿是有效的，这可以帮助牙医和患者做出更好的决定，以保护牙齿和维护口腔健康。
{"title":"Change in tooth mobility following non‐surgical periodontal therapy: A retrospective cohort study of clinical outcomes","authors":"Georgios S. Chatzopoulos, Larry F. Wolff","doi":"10.1002/jper.70046","DOIUrl":"https://doi.org/10.1002/jper.70046","url":null,"abstract":"Background To evaluate the change in clinical tooth mobility following scaling and root planing (SRP) and to identify baseline factors predictive of the 12‐month outcome. Methods This retrospective cohort study utilized de‐identified electronic health records from the BigMouth Dental Data Repository. The final cohort consisted of 152 patients, contributing 489 teeth with baseline mobility of Class 1, 2, or 3. The primary outcome was the change in mobility class at 12 months. A multilevel cumulative link model (ordinal logistic regression) was used to determine the association between baseline factors (including splinting status) and the 12‐month mobility outcome. Results Scaling and root planing resulted in a substantial reduction in tooth mobility. At 12 months, 71.2% of teeth with initial Class 1 mobility and 42.2% of teeth with initial Class 2 mobility became clinically stable (Class 0). The multilevel regression analysis identified several factors significantly associated with higher odds of a less favorable outcome: higher initial mobility, deeper probing depths, furcation involvement, smoking, and diabetes ( <jats:italic>p</jats:italic> < 0.05). The presence of a splint/stabilization was significantly associated with higher odds of a more favorable mobility outcome (OR = 2.15, <jats:italic>p</jats:italic> < 0.01). Conclusions Within the limitations of this retrospective study, SRP appears effective in reducing tooth mobility within 1 year. The identified predictors can help clinicians to manage patient's expectations and to highlight cases that may require more intensive therapy or monitoring. Plain language summary Severe gum disease can cause teeth to become loose, putting them at risk of being lost. This study investigated whether a common “deep cleaning” procedure (non‐surgical periodontal therapy) could help to stabilize these loose teeth. We analyzed the de‐identified dental records of 152 patients from eight U.S. university clinics, tracking the outcomes of 489 loose teeth for 1 year after treatment. Our results showed that the deep cleaning was very successful. Most teeth, even those that were moderately or severely loose, became significantly firmer. For example, more than 70% of slightly loose teeth became completely stable again. We also identified factors that made a successful outcome less likely, including smoking, diabetes, having more severe gum disease, or having a very loose tooth to begin with. This research provides evidence that this routine therapy is effective in tightening loose teeth, which can help dentists and patients to make better‐informed decisions about saving teeth and maintaining oral health.","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"159 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000895","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 Fibroblast growth factor‐2 (FGF‐2) is a novel agent utilized in periodontal regeneration therapy. However, its clinical efficacy compared with autologous bone graft (ABG), a long‐established treatment, remains unclear. This study aimed to compare the clinical outcomes of FGF‐2 and ABG and to assess the impact of patient background factors on outcomes when using FGF‐2. Methods We collected the subjects from January 2013 to September 2023. Clinical outcomes included the vertical bone defect improvement rate (VBDIR) and the probing pocket depth improvement (PPDI). Clinical outcomes between the two groups were compared using analysis of covariance (ANCOVA), adjusting for age, sex, smoking history, and hypertension. Additionally, a multilevel linear analysis was performed to assess factors influencing outcomes in FGF‐2. Results A total of 180 sites from 141 patients (FGF‐2: 150 sites; ABG: 30 sites) were evaluated. Both VBDIR and PPDI significantly improved postoperatively in both groups. There were no significant differences in clinical outcomes between FGF‐2 and ABG. In FGF‐2, smoking history was positively associated, while the preoperative bone defect angle (BDA) was negatively associated with clinical outcomes. Conclusions FGF‐2 might exhibit clinical outcomes comparable to those of ABG, suggesting it is a clinically viable alternative for vertical bone defects. When using FGF‐2, patient‐specific factors such as smoking history and preoperative BDA should be considered carefully. The name in the trial registry A survey of clinical practice and evaluation of treatment outcomes of periodontal regenerative therapy using REGROTH at Okayama University Hospital Plain Language Summary This retrospective study compared the clinical outcomes of fibroblast growth factor‐2 (FGF‐2), a novel therapeutic agent, with autologous bone graft (ABG), a long‐established treatment. A total of 180 sites from 141 patients (150 FGF‐2 sites, 30 ABG sites) were evaluated based on the vertical bone defect improvement rate (VBDIR) and the probing pocket depth improvement (PPDI). Using analysis of covariance (ANCOVA), adjusted for patient background factors such as age, sex, smoking history, and hypertension, no significant differences in clinical outcomes were observed between the two treatment groups. Further multilevel linear analysis focusing on the FGF‐2 group revealed that smoking history was positively associated, while preoperative bone defect angle (BDA) was negatively associated with clinical outcomes. These findings suggest that FGF‐2 may offer clinical benefits comparable to ABG in treating vertical bone defects while having the added advantage of being less invasive. However, when using FGF‐2, dentists should consider individual patient factors such as smoking habits and defect morphology, as these may influence treatment outcomes.
{"title":"A retrospective cohort study comparing periodontal regeneration using fibroblast growth factor‐2 versus autologous bone graft","authors":"Toshiki Matsumoto, Shin Nakamura, Yuki Ito‐Shinoda, Mai Sakamoto, Takayuki Ishii, Yasuki Nonomura, Hidetaka Ideguchi, Keisuke Okubo, Kazu Takeuchi‐Hatanaka, Kazuhiro Omori, Tadashi Yamamoto, Shogo Takashiba","doi":"10.1002/jper.70060","DOIUrl":"https://doi.org/10.1002/jper.70060","url":null,"abstract":"Background Fibroblast growth factor‐2 (FGF‐2) is a novel agent utilized in periodontal regeneration therapy. However, its clinical efficacy compared with autologous bone graft (ABG), a long‐established treatment, remains unclear. This study aimed to compare the clinical outcomes of FGF‐2 and ABG and to assess the impact of patient background factors on outcomes when using FGF‐2. Methods We collected the subjects from January 2013 to September 2023. Clinical outcomes included the vertical bone defect improvement rate (VBDIR) and the probing pocket depth improvement (PPDI). Clinical outcomes between the two groups were compared using analysis of covariance (ANCOVA), adjusting for age, sex, smoking history, and hypertension. Additionally, a multilevel linear analysis was performed to assess factors influencing outcomes in FGF‐2. Results A total of 180 sites from 141 patients (FGF‐2: 150 sites; ABG: 30 sites) were evaluated. Both VBDIR and PPDI significantly improved postoperatively in both groups. There were no significant differences in clinical outcomes between FGF‐2 and ABG. In FGF‐2, smoking history was positively associated, while the preoperative bone defect angle (BDA) was negatively associated with clinical outcomes. Conclusions FGF‐2 might exhibit clinical outcomes comparable to those of ABG, suggesting it is a clinically viable alternative for vertical bone defects. When using FGF‐2, patient‐specific factors such as smoking history and preoperative BDA should be considered carefully. The name in the trial registry A survey of clinical practice and evaluation of treatment outcomes of periodontal regenerative therapy using REGROTH at Okayama University Hospital Plain Language Summary This retrospective study compared the clinical outcomes of fibroblast growth factor‐2 (FGF‐2), a novel therapeutic agent, with autologous bone graft (ABG), a long‐established treatment. A total of 180 sites from 141 patients (150 FGF‐2 sites, 30 ABG sites) were evaluated based on the vertical bone defect improvement rate (VBDIR) and the probing pocket depth improvement (PPDI). Using analysis of covariance (ANCOVA), adjusted for patient background factors such as age, sex, smoking history, and hypertension, no significant differences in clinical outcomes were observed between the two treatment groups. Further multilevel linear analysis focusing on the FGF‐2 group revealed that smoking history was positively associated, while preoperative bone defect angle (BDA) was negatively associated with clinical outcomes. These findings suggest that FGF‐2 may offer clinical benefits comparable to ABG in treating vertical bone defects while having the added advantage of being less invasive. However, when using FGF‐2, dentists should consider individual patient factors such as smoking habits and defect morphology, as these may influence treatment outcomes.","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"100 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000945","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 Intrabony periodontal defects present a clinical challenge. Decortication, also called intramarrow penetration (IMP), intended to stimulate angiogenesis and to enhance the healing environment, has demonstrated benefits in bone augmentation but remains insufficiently investigated in periodontal regenerative procedures, especially in combination with enamel matrix derivative (EMD). Methods This retrospective cohort study included patients treated with EMD alone (control group) or with EMD combined with IMP (test group). The primary outcome was clinical attachment level (CAL) gain at 12 months. Secondary outcomes included probing pocket depth (PPD), gingival recession (REC), keratinized tissue width (KTW), and radiographic parameters such as defect depth (rDD), defect width (rDW), and defect angle (rANG). Linear regression with generalized estimating equations (GEE) was used to account for clustering, with Bonferroni correction for multiple comparisons. The significance was set at α = 0.05. Results A total of 29 patients (39 teeth) were included. Both groups exhibited statistically significant improvements in clinical and radiographic parameters between baseline and 12 months ( p < 0.05). In the test group, the mean PPD decreased by 3.86 ± 1.73 mm, the CAL gain was 3.18 ± 1.30 mm, and the REC increased by 0.68 ± 1.21 mm; radiographically, rDD and rDW were significantly reduced, whereas rANG did not change significantly. Similarly, in the control group, PPD decreased by 3.47 ± 1.33 mm, CAL gain was 2.82 ± 1.29 mm, REC increased by 0.65 ± 1.00 mm, and significant reductions in rDD and rDW were observed. No statistically significant differences were found between the two groups for any parameter at 12 months ( p > 0.05). Conclusions The adjunctive use of IMP did not significantly enhance the clinical or radiographic outcomes achieved with EMD alone. However, the comparable outcomes achieved in more challenging baseline conditions indicate that the technique merits further investigation in future randomized controlled studies.
{"title":"Periodontal regeneration with enamel matrix derivative and decortication: A retrospective analysis of one year clinical and radiographic outcomes","authors":"Margherita Giorgia Liguori, Leonardo Mancini, Cosimo Rupe, Gianluca Vittorini Orgeas, Cristiano Littarru, Carlo Lajolo, Alessandro Crea","doi":"10.1002/jper.70067","DOIUrl":"https://doi.org/10.1002/jper.70067","url":null,"abstract":"Background Intrabony periodontal defects present a clinical challenge. Decortication, also called intramarrow penetration (IMP), intended to stimulate angiogenesis and to enhance the healing environment, has demonstrated benefits in bone augmentation but remains insufficiently investigated in periodontal regenerative procedures, especially in combination with enamel matrix derivative (EMD). Methods This retrospective cohort study included patients treated with EMD alone (control group) or with EMD combined with IMP (test group). The primary outcome was clinical attachment level (CAL) gain at 12 months. Secondary outcomes included probing pocket depth (PPD), gingival recession (REC), keratinized tissue width (KTW), and radiographic parameters such as defect depth (rDD), defect width (rDW), and defect angle (rANG). Linear regression with generalized estimating equations (GEE) was used to account for clustering, with Bonferroni correction for multiple comparisons. The significance was set at α = 0.05. Results A total of 29 patients (39 teeth) were included. Both groups exhibited statistically significant improvements in clinical and radiographic parameters between baseline and 12 months ( <jats:italic>p</jats:italic> < 0.05). In the test group, the mean PPD decreased by 3.86 ± 1.73 mm, the CAL gain was 3.18 ± 1.30 mm, and the REC increased by 0.68 ± 1.21 mm; radiographically, rDD and rDW were significantly reduced, whereas rANG did not change significantly. Similarly, in the control group, PPD decreased by 3.47 ± 1.33 mm, CAL gain was 2.82 ± 1.29 mm, REC increased by 0.65 ± 1.00 mm, and significant reductions in rDD and rDW were observed. No statistically significant differences were found between the two groups for any parameter at 12 months ( <jats:italic>p</jats:italic> > 0.05). Conclusions The adjunctive use of IMP did not significantly enhance the clinical or radiographic outcomes achieved with EMD alone. However, the comparable outcomes achieved in more challenging baseline conditions indicate that the technique merits further investigation in future randomized controlled studies.","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"272 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000893","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}
Meng Xuan Chen, Yue Yu, Chen Xuan Wei, Hamoun Sabri, Muhammad H. A. Saleh
Objectives To assess associations between the poverty‐income ratio (PIR) and periodontitis severity using Application of the 2018 Periodontal Status Classification to Epidemiological Survey Data (ACES) framework. Methods Three NHANES cycles (2009–2014) with adults aged ≥30 years with complete periodontal examinations ( <jats:italic>n</jats:italic> = 10,598) were included. Staging (I–IV), grading (A–C), and extent (localized/generalized) were derived. The primary exposure was the poverty‐income ratio. The covariates included smoking (current/former/never), HbA1c, and BMI. The analytic sample for the PIR main effects was <jats:italic>n</jats:italic> = 9708. Stage/grade used multinomial logistic regression; extent used binary logistic regression. Full models included the main effects and interactions; non‐significant interactions were removed. Significance was set at <jats:italic>p </jats:italic> < 0.05. Analyses were performed in R. Results A higher PIR was protective across outcomes: stage IV versus I RRR = 0.58, stage III 0.73; and stage II 0.87 ( <jats:italic>p </jats:italic> < 0.001); grade C versus A 0.74, grade B 0.83 ( <jats:italic>p </jats:italic> < 0.001); generalized extent OR = 0.93 ( <jats:italic>p </jats:italic> < 0.001). Smoking showed a graded risk: current versus never – stage III RRR = 2.19, stage IV 3.82 ( <jats:italic>p </jats:italic> < 0.001); grade B 1.57, grade C 2.18 ( <jats:italic>p </jats:italic> < 0.001); generalized OR = 1.46 ( <jats:italic>p </jats:italic> < 0.001); former versus never generalized OR not significant ( <jats:italic>p </jats:italic> = 0.24). The HbA1c increases were associated with a higher severity: stages II–IV versus I RRRs = 1.56/1.97/2.14 (all <jats:italic>p </jats:italic> < 0.001); grades B/C versus A 1.58/1.82 ( <jats:italic>p </jats:italic> < 0.001); extent OR = 1.00 ( <jats:italic>p </jats:italic> = 0.81). With BMI models, the BMI showed slight associations for stage/grade (RRR≈0.93–0.98), while the PIR remained strongly associated: stage II/III/IV RRRs = 0.69/0.48/0.30 (all <jats:italic>p </jats:italic> < 0.001); grade B/C 0.54/0.43 ( <jats:italic>p </jats:italic> < 0.001); extent OR for PIR = 0.93 ( <jats:italic>p </jats:italic> < 0.001), BMI OR = 1.00 ( <jats:italic>p </jats:italic> = 0.184). Conclusions Within the limitations of this cross‐sectional analysis, a higher PIR was associated with a lower periodontitis severity, smoking, and higher HbA1c with higher severity, and the BMI effects were minimal. Plain Language Summary Gum disease is common and tied to overall health. People with less income and consequently fewer resources for preventative care may face a higher risk for disease. We analyzed three cycles of the US National Health and Nutrition Examination Survey (2009–2014). Adults aged ≥30 years with complete dental examinations ( <jats:italic>n</jats:italic> = 10,598) were classified using the 2018 staging/grading system that defines disease severi
{"title":"Periodontitis severity and its social and clinical determinants: An ACES framework‐based NHANES analysis","authors":"Meng Xuan Chen, Yue Yu, Chen Xuan Wei, Hamoun Sabri, Muhammad H. A. Saleh","doi":"10.1002/jper.70064","DOIUrl":"https://doi.org/10.1002/jper.70064","url":null,"abstract":"Objectives To assess associations between the poverty‐income ratio (PIR) and periodontitis severity using Application of the 2018 Periodontal Status Classification to Epidemiological Survey Data (ACES) framework. Methods Three NHANES cycles (2009–2014) with adults aged ≥30 years with complete periodontal examinations ( <jats:italic>n</jats:italic> = 10,598) were included. Staging (I–IV), grading (A–C), and extent (localized/generalized) were derived. The primary exposure was the poverty‐income ratio. The covariates included smoking (current/former/never), HbA1c, and BMI. The analytic sample for the PIR main effects was <jats:italic>n</jats:italic> = 9708. Stage/grade used multinomial logistic regression; extent used binary logistic regression. Full models included the main effects and interactions; non‐significant interactions were removed. Significance was set at <jats:italic>p </jats:italic> < 0.05. Analyses were performed in R. Results A higher PIR was protective across outcomes: stage IV versus I RRR = 0.58, stage III 0.73; and stage II 0.87 ( <jats:italic>p </jats:italic> < 0.001); grade C versus A 0.74, grade B 0.83 ( <jats:italic>p </jats:italic> < 0.001); generalized extent OR = 0.93 ( <jats:italic>p </jats:italic> < 0.001). Smoking showed a graded risk: current versus never – stage III RRR = 2.19, stage IV 3.82 ( <jats:italic>p </jats:italic> < 0.001); grade B 1.57, grade C 2.18 ( <jats:italic>p </jats:italic> < 0.001); generalized OR = 1.46 ( <jats:italic>p </jats:italic> < 0.001); former versus never generalized OR not significant ( <jats:italic>p </jats:italic> = 0.24). The HbA1c increases were associated with a higher severity: stages II–IV versus I RRRs = 1.56/1.97/2.14 (all <jats:italic>p </jats:italic> < 0.001); grades B/C versus A 1.58/1.82 ( <jats:italic>p </jats:italic> < 0.001); extent OR = 1.00 ( <jats:italic>p </jats:italic> = 0.81). With BMI models, the BMI showed slight associations for stage/grade (RRR≈0.93–0.98), while the PIR remained strongly associated: stage II/III/IV RRRs = 0.69/0.48/0.30 (all <jats:italic>p </jats:italic> < 0.001); grade B/C 0.54/0.43 ( <jats:italic>p </jats:italic> < 0.001); extent OR for PIR = 0.93 ( <jats:italic>p </jats:italic> < 0.001), BMI OR = 1.00 ( <jats:italic>p </jats:italic> = 0.184). Conclusions Within the limitations of this cross‐sectional analysis, a higher PIR was associated with a lower periodontitis severity, smoking, and higher HbA1c with higher severity, and the BMI effects were minimal. Plain Language Summary Gum disease is common and tied to overall health. People with less income and consequently fewer resources for preventative care may face a higher risk for disease. We analyzed three cycles of the US National Health and Nutrition Examination Survey (2009–2014). Adults aged ≥30 years with complete dental examinations ( <jats:italic>n</jats:italic> = 10,598) were classified using the 2018 staging/grading system that defines disease severi","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"36 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146000894","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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