Varkha Rattu, Tishani Patel, Jasmine Loke, Hari Petsos, Luigi Nibali
Background Periodontitis requires long‐term management to prevent recurrence and tooth loss. While active periodontal therapy (APT) aims to reduce probing pocket depth (PPD) and improve clinical attachment level (CAL), strict supportive periodontal care (SPC) is essential for maintaining these clinical outcomes. This study systematically reviewed the long‐term benefits of APT interventions (test groups) compared to standard control interventions (control groups) in patients undergoing SPC as part of randomized controlled trials (RCTs). Methods A systematic search of databases and journals identified RCTs with a minimum follow‐up of 10 years. Studies comparing APT interventions, such as regenerative techniques, to standard care in patients adhering to SPC were included. Primary outcomes assessed included tooth loss, and secondary outcomes included PPD reduction, CAL gain, and patient‐reported outcome measures (PROMs). Descriptive analyses were undertaken on all studies, and meta‐analyses were conducted to analyze the weighted mean differences (WMDs) for PPD, CAL, and tooth loss between test and control interventions when appropriate. Results From an initial screening of 4582 articles, 9 were deemed suitable and included for descriptive analyses. Four publications of 3 studies were included in meta‐analyses comparing guided tissue regeneration (GTR) and open flap debridement (OFD) over a 10‐to 20‐year SPC follow‐ups. Regenerative techniques demonstrated significant CAL gains at 1‐year follow‐up compared to control groups. At 10 to 20 years, PPD and CAL outcomes were comparable between groups. Tooth loss was minimal across all groups. Variability in SPC protocols and operator experience may have influenced outcomes. Conclusions Long‐term periodontal stability does not appear to be affected by the choice of initial intervention in patients who adhere to a rigorous SPC program. While regenerative techniques offer short‐term advantages, their long‐term benefits may reduce in comparison to non‐regenerative methods under SPC. Future research should focus on standardized SPC protocols and cost‐effectiveness to optimize periodontal care. Plain language summary Periodontitis is a chronic immune‐inflammatory condition that can lead to increased risk of tooth loss if not managed. Treatment such as non‐surgical periodontal therapy (NSPT), adjunctive therapies, or various surgeries can improve periodontal health. This systematic review examined randomized controlled trials (RCTs) where patients received different periodontal treatments and were then followed up for ≥10 years while attending maintenance visits. Periodontal surrogate and true endpoints were compared between the test and control groups. The findings suggest that long‐term outcomes were similar between groups, provided patients remained in consistent maintenance care. This highlights that the key to long‐term success is not necessarily which active treatment is used, but possibly the adherence to s
{"title":"Long‐term clinical benefits of periodontal interventions in strict supportive periodontal care: A systematic review","authors":"Varkha Rattu, Tishani Patel, Jasmine Loke, Hari Petsos, Luigi Nibali","doi":"10.1002/jper.70027","DOIUrl":"https://doi.org/10.1002/jper.70027","url":null,"abstract":"Background Periodontitis requires long‐term management to prevent recurrence and tooth loss. While active periodontal therapy (APT) aims to reduce probing pocket depth (PPD) and improve clinical attachment level (CAL), strict supportive periodontal care (SPC) is essential for maintaining these clinical outcomes. This study systematically reviewed the long‐term benefits of APT interventions (test groups) compared to standard control interventions (control groups) in patients undergoing SPC as part of randomized controlled trials (RCTs). Methods A systematic search of databases and journals identified RCTs with a minimum follow‐up of 10 years. Studies comparing APT interventions, such as regenerative techniques, to standard care in patients adhering to SPC were included. Primary outcomes assessed included tooth loss, and secondary outcomes included PPD reduction, CAL gain, and patient‐reported outcome measures (PROMs). Descriptive analyses were undertaken on all studies, and meta‐analyses were conducted to analyze the weighted mean differences (WMDs) for PPD, CAL, and tooth loss between test and control interventions when appropriate. Results From an initial screening of 4582 articles, 9 were deemed suitable and included for descriptive analyses. Four publications of 3 studies were included in meta‐analyses comparing guided tissue regeneration (GTR) and open flap debridement (OFD) over a 10‐to 20‐year SPC follow‐ups. Regenerative techniques demonstrated significant CAL gains at 1‐year follow‐up compared to control groups. At 10 to 20 years, PPD and CAL outcomes were comparable between groups. Tooth loss was minimal across all groups. Variability in SPC protocols and operator experience may have influenced outcomes. Conclusions Long‐term periodontal stability does not appear to be affected by the choice of initial intervention in patients who adhere to a rigorous SPC program. While regenerative techniques offer short‐term advantages, their long‐term benefits may reduce in comparison to non‐regenerative methods under SPC. Future research should focus on standardized SPC protocols and cost‐effectiveness to optimize periodontal care. Plain language summary Periodontitis is a chronic immune‐inflammatory condition that can lead to increased risk of tooth loss if not managed. Treatment such as non‐surgical periodontal therapy (NSPT), adjunctive therapies, or various surgeries can improve periodontal health. This systematic review examined randomized controlled trials (RCTs) where patients received different periodontal treatments and were then followed up for ≥10 years while attending maintenance visits. Periodontal surrogate and true endpoints were compared between the test and control groups. The findings suggest that long‐term outcomes were similar between groups, provided patients remained in consistent maintenance care. This highlights that the key to long‐term success is not necessarily which active treatment is used, but possibly the adherence to s","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"120 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145535255","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 investigated the association of inflammatory markers in saliva, plasma, and cerebrospinal fluid (CSF) with cognitive decline and periodontitis.METHODSPatients with Alzheimer disease (AD, n = 52), mild cognitive impairment (MCI, n = 51), subjective cognitive decline (SCD, n = 51), and controls (n = 76) between 50 and 80 years were included. Participants underwent an oral examination, and blood and stimulated saliva were collected. In addition, CSF samples were collected from patients but not controls. Levels of interleukin (IL)-1β, IL-8, IL-10, IL-17A, and tumor necrosis factor-alpha (TNF-α) were analyzed by multiplex immunoassays.RESULTSIncreased salivary levels of IL-1β, IL-10, and IL-17A were found in MCI compared to controls, while in plasma increased IL-8 levels were seen in all 3 patient groups compared to controls (p < 0.001). TNF-α plasma levels were higher in SCD and AD (p < 0.05). IL-17A levels in CSF were higher in participants with no/mild periodontitis compared to generalized periodontitis (p = 0.023). Participants with severe periodontitis showed higher levels of IL-8 both in saliva (p = 0.027) and plasma (p < 0.001), as well as higher TNF-α levels in plasma (p = 0.041).CONCLUSIONSInflammation markers could indicate an increased risk for cognitive decline, especially in cases of more severe periodontitis.PLAIN LANGUAGE SUMMARYEvidence has indicated an association between periodontitis and cognitive impairment. Hence, this study investigated whether inflammatory markers in saliva, plasma, and cerebrospinal fluid are associated with cognitive decline. Cases with mild or more severe signs of cognitive impairment had more signs of periodontal disease. Levels of some, but not all, inflammation markers were elevated among patients compared to cognitively healthy controls. Oral inflammation could indicate an increased risk for cognitive decline, and chronic inflammation may act as a common pathway. Early periodontal intervention and maintaining oral health may contribute to cognitive well-being.
本研究调查了唾液、血浆和脑脊液（CSF）中炎症标志物与认知能力下降和牙周炎的关系。方法纳入年龄在50 ~ 80岁的阿尔茨海默病（AD, n = 52）、轻度认知障碍（MCI, n = 51）、主观认知能力下降（SCD, n = 51）和对照组（n = 76）患者。参与者接受了口腔检查，并收集了血液和刺激唾液。此外，收集了患者的脑脊液样本，而不是对照组。采用多重免疫分析法分析白细胞介素(IL)-1β、IL-8、IL-10、IL- 17a和肿瘤坏死因子-α (TNF-α)的水平。结果与对照组相比，MCI患者唾液中IL-1β、IL-10和IL-17A水平均升高，血浆中IL-8水平均升高（p < 0.001）。SCD和AD患者血浆TNF-α水平较高（p < 0.05）。与全身性牙周炎患者相比，无/轻度牙周炎患者脑脊液中IL-17A水平较高（p = 0.023）。患有严重牙周炎的参与者在唾液（p = 0.027）和血浆（p < 0.001）中显示出较高的IL-8水平，以及血浆中较高的TNF-α水平（p = 0.041）。结论：炎症标志物可能表明认知能力下降的风险增加，特别是在牙周炎较严重的情况下。有证据表明牙周炎和认知障碍之间存在关联。因此，本研究调查了唾液、血浆和脑脊液中的炎症标志物是否与认知能力下降有关。轻度或更严重的认知障碍患者有更多的牙周病症状。与认知健康的对照组相比，患者中一些（但不是全部）炎症标志物的水平有所升高。口腔炎症可能表明认知能力下降的风险增加，而慢性炎症可能是一个常见的途径。早期牙周干预和保持口腔健康可能有助于认知健康。
{"title":"The association of periodontal inflammation and inflammatory markers with cognitive dysfunction: A case-control study.","authors":"Kåre Buhlin,Maria Eriksdotter,Leif Jansson,Pirkko J Pussinen,Marianne Schultzberg,Ronaldo Lira-Junior","doi":"10.1002/jper.70020","DOIUrl":"https://doi.org/10.1002/jper.70020","url":null,"abstract":"BACKGROUNDThis study investigated the association of inflammatory markers in saliva, plasma, and cerebrospinal fluid (CSF) with cognitive decline and periodontitis.METHODSPatients with Alzheimer disease (AD, n = 52), mild cognitive impairment (MCI, n = 51), subjective cognitive decline (SCD, n = 51), and controls (n = 76) between 50 and 80 years were included. Participants underwent an oral examination, and blood and stimulated saliva were collected. In addition, CSF samples were collected from patients but not controls. Levels of interleukin (IL)-1β, IL-8, IL-10, IL-17A, and tumor necrosis factor-alpha (TNF-α) were analyzed by multiplex immunoassays.RESULTSIncreased salivary levels of IL-1β, IL-10, and IL-17A were found in MCI compared to controls, while in plasma increased IL-8 levels were seen in all 3 patient groups compared to controls (p < 0.001). TNF-α plasma levels were higher in SCD and AD (p < 0.05). IL-17A levels in CSF were higher in participants with no/mild periodontitis compared to generalized periodontitis (p = 0.023). Participants with severe periodontitis showed higher levels of IL-8 both in saliva (p = 0.027) and plasma (p < 0.001), as well as higher TNF-α levels in plasma (p = 0.041).CONCLUSIONSInflammation markers could indicate an increased risk for cognitive decline, especially in cases of more severe periodontitis.PLAIN LANGUAGE SUMMARYEvidence has indicated an association between periodontitis and cognitive impairment. Hence, this study investigated whether inflammatory markers in saliva, plasma, and cerebrospinal fluid are associated with cognitive decline. Cases with mild or more severe signs of cognitive impairment had more signs of periodontal disease. Levels of some, but not all, inflammation markers were elevated among patients compared to cognitively healthy controls. Oral inflammation could indicate an increased risk for cognitive decline, and chronic inflammation may act as a common pathway. Early periodontal intervention and maintaining oral health may contribute to cognitive well-being.","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"13 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477703","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}
Gaetano Isola, Marco Annunziata, Angela Angjelova, Angela Alibrandi, Gianluca Martino Tartaglia, Frank A. Scannapieco
Background A randomized, controlled trial was conducted to evaluate the effectiveness of two supportive periodontal care (SPC) approaches in patients with periodontitis and to evaluate possible predictors influencing bleeding on probing (BoP) changes at 24‐month follow‐up. Methods Fifty‐six periodontitis patients who first received active periodontal treatment by means of quadrant‐wise subgingival instrumentation were subsequently assigned to either a control group (oral hygiene instruction with supragingival instrumentation and dental polishing, <jats:italic>n</jats:italic> = 28) or a test group (oral hygiene instruction with both supra‐ and subgingival instrumentation and dental polishing, <jats:italic>n</jats:italic> = 28). BoP was the primary outcome, and probing pocket depth (PPD), clinical attachment level (CAL), full‐mouth plaque score (FMPS), gingival bleeding index (GBI), and the number of pocket sites were secondary outcome measures, recorded up to 24 months of follow‐up. A mixed generalized linear regression analysis also assessed the potential confounding factors that influenced BoP changes at 24 months. Results At 24 months, both groups showed significant improvement in periodontal outcomes ( <jats:italic>p</jats:italic> < 0.05). The test intervention was more effective than the control in reducing median BoP ( <jats:italic>p</jats:italic> = 0.033), GBI ( <jats:italic>p</jats:italic> = 0.023), the number of pockets ≥4 mm with BoP ( <jats:italic>p</jats:italic> = 0.018), 4–5 mm ( <jats:italic>p</jats:italic> = 0.048), 5–6 mm ( <jats:italic>p</jats:italic> = 0.011), and >6 mm ( <jats:italic>p</jats:italic> = 0.023). Among all follow‐up sessions, the reduced BoP was significantly negatively influenced by the number of median PPD ( <jats:italic>p</jats:italic> = 0.031), the number of pockets 4–5 mm ( <jats:italic>p</jats:italic> = 0.029), PPD 5–6 mm ( <jats:italic>p</jats:italic> = 0.036), smoking ( <jats:italic>p</jats:italic> = 0.039), and by the number of cigarettes/day ( <jats:italic>p</jats:italic> = 0.042) and positively by test treatment ( <jats:italic>p</jats:italic> = 0.033). Conclusion SPC that included subgingival instrumentation yielded better results than the control to reduce BoP at 24‐month follow‐up. Smoking and deep pockets negatively influenced the BoP reduction in patients who underwent SPC. Plain Language Summary Supportive periodontal care (SPC) is a series of individualized, site‐specific treatments aimed at preventing periodontitis recurrence/progression after successful completion of active periodontal therapy. SPC approaches performed by means of oral hygiene instruction with supra‐ and subgingival instrumentation and dental polishing (test group) compared to oral hygiene with supragingival instrumentation alone and dental polishing (control group) were both effective in reducing median periodontal outcomes, such as bleeding on probing (BoP), probing pocket depth (PPD), clinical attachment level (CAL), and
{"title":"Effectiveness of two supportive periodontal care protocols and outcome predictors during periodontitis: A randomized controlled trial","authors":"Gaetano Isola, Marco Annunziata, Angela Angjelova, Angela Alibrandi, Gianluca Martino Tartaglia, Frank A. Scannapieco","doi":"10.1002/jper.70007","DOIUrl":"https://doi.org/10.1002/jper.70007","url":null,"abstract":"Background A randomized, controlled trial was conducted to evaluate the effectiveness of two supportive periodontal care (SPC) approaches in patients with periodontitis and to evaluate possible predictors influencing bleeding on probing (BoP) changes at 24‐month follow‐up. Methods Fifty‐six periodontitis patients who first received active periodontal treatment by means of quadrant‐wise subgingival instrumentation were subsequently assigned to either a control group (oral hygiene instruction with supragingival instrumentation and dental polishing, <jats:italic>n</jats:italic> = 28) or a test group (oral hygiene instruction with both supra‐ and subgingival instrumentation and dental polishing, <jats:italic>n</jats:italic> = 28). BoP was the primary outcome, and probing pocket depth (PPD), clinical attachment level (CAL), full‐mouth plaque score (FMPS), gingival bleeding index (GBI), and the number of pocket sites were secondary outcome measures, recorded up to 24 months of follow‐up. A mixed generalized linear regression analysis also assessed the potential confounding factors that influenced BoP changes at 24 months. Results At 24 months, both groups showed significant improvement in periodontal outcomes ( <jats:italic>p</jats:italic> < 0.05). The test intervention was more effective than the control in reducing median BoP ( <jats:italic>p</jats:italic> = 0.033), GBI ( <jats:italic>p</jats:italic> = 0.023), the number of pockets ≥4 mm with BoP ( <jats:italic>p</jats:italic> = 0.018), 4–5 mm ( <jats:italic>p</jats:italic> = 0.048), 5–6 mm ( <jats:italic>p</jats:italic> = 0.011), and >6 mm ( <jats:italic>p</jats:italic> = 0.023). Among all follow‐up sessions, the reduced BoP was significantly negatively influenced by the number of median PPD ( <jats:italic>p</jats:italic> = 0.031), the number of pockets 4–5 mm ( <jats:italic>p</jats:italic> = 0.029), PPD 5–6 mm ( <jats:italic>p</jats:italic> = 0.036), smoking ( <jats:italic>p</jats:italic> = 0.039), and by the number of cigarettes/day ( <jats:italic>p</jats:italic> = 0.042) and positively by test treatment ( <jats:italic>p</jats:italic> = 0.033). Conclusion SPC that included subgingival instrumentation yielded better results than the control to reduce BoP at 24‐month follow‐up. Smoking and deep pockets negatively influenced the BoP reduction in patients who underwent SPC. Plain Language Summary Supportive periodontal care (SPC) is a series of individualized, site‐specific treatments aimed at preventing periodontitis recurrence/progression after successful completion of active periodontal therapy. SPC approaches performed by means of oral hygiene instruction with supra‐ and subgingival instrumentation and dental polishing (test group) compared to oral hygiene with supragingival instrumentation alone and dental polishing (control group) were both effective in reducing median periodontal outcomes, such as bleeding on probing (BoP), probing pocket depth (PPD), clinical attachment level (CAL), and ","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"91 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461284","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 Patients with periodontitis can exhibit persistent periodontal pockets with bleeding representative of inflammation. This clinical study aimed to evaluate the effectiveness of a chitosan brush in improving residual periodontal pockets in patients who had already undergone causative therapy for periodontitis. Methods Thirty‐six patients with stage III or IV periodontitis, showing residual pockets that bled on probing, were randomly assigned to 2 groups. The test group received debridement using both an ultrasonic scaler and a chitosan brush, while the control group received only ultrasonic scaling. Clinical parameters—probing pocket depth (PPD), clinical attachment level (CAL), recession (REC), and bleeding on probing (BoP)—were assessed at baseline, 6 weeks, 3 months, and 6 months posttreatment. Gingival crevicular fluid (GCF) was also collected to measure matrix metalloproteinase‐8 (MMP‐8) levels, a marker of inflammation. Results Results showed significant improvements in clinical parameters over time in both groups. Probing depth and clinical attachment loss significantly improved from baseline to 3 months, with slight increases observed from 3 to 6 months. However, no significant differences between groups were found in these parameters. Gingival recession increased in both groups, with no group difference. BoP improved gradually in the test group, while in the control group, it initially decreased but increased again by 6 months, with a significant difference between groups at 6 months ( p = 0.007). MMP‐8 levels decreased in both groups from baseline to 3 months but increased thereafter, with no significant difference between groups. Conclusion In conclusion, the chitosan brush, when added to mechanical debridement, led to better improvement in BoP compared to ultrasonic scaling alone, but did not show superior results for other clinical parameters or MMP‐8 levels. Clinical Trial Registration The trial is registered at the US National Library of Medicine ClinicalTrials.gov (NCT06127069). Plain Language Summary After periodontal therapy, patients with periodontitis may still have persistent periodontal pockets with bleeding on probing, indicating ongoing inflammation. However, retreating these pockets can be unpredictable. This study investigated the effectiveness of a new chitosan brush for treating these pockets. Results showed that its use did not improve all clinical parameters, but significantly reduced bleeding—indicating less inflammation—at the treated sites 6 months after therapy. The absence of bleeding is crucial in preventing disease progression. Maintaining clinically healthy sites during the maintenance phase is essential for long‐term positive outcomes and helps reduce the risk of further gum disease progression.
{"title":"Management of residual periodontal pockets using an oscillating chitosan device: A randomized clinical trial","authors":"Georgia Tseleki, Leonidas Batas, Sotiria Davidopoulou, Johan Caspar Wohlfahrt, Georgios Menexes, Lazaros Tsalikis","doi":"10.1002/jper.70010","DOIUrl":"https://doi.org/10.1002/jper.70010","url":null,"abstract":"Background Patients with periodontitis can exhibit persistent periodontal pockets with bleeding representative of inflammation. This clinical study aimed to evaluate the effectiveness of a chitosan brush in improving residual periodontal pockets in patients who had already undergone causative therapy for periodontitis. Methods Thirty‐six patients with stage III or IV periodontitis, showing residual pockets that bled on probing, were randomly assigned to 2 groups. The test group received debridement using both an ultrasonic scaler and a chitosan brush, while the control group received only ultrasonic scaling. Clinical parameters—probing pocket depth (PPD), clinical attachment level (CAL), recession (REC), and bleeding on probing (BoP)—were assessed at baseline, 6 weeks, 3 months, and 6 months posttreatment. Gingival crevicular fluid (GCF) was also collected to measure matrix metalloproteinase‐8 (MMP‐8) levels, a marker of inflammation. Results Results showed significant improvements in clinical parameters over time in both groups. Probing depth and clinical attachment loss significantly improved from baseline to 3 months, with slight increases observed from 3 to 6 months. However, no significant differences between groups were found in these parameters. Gingival recession increased in both groups, with no group difference. BoP improved gradually in the test group, while in the control group, it initially decreased but increased again by 6 months, with a significant difference between groups at 6 months ( <jats:italic>p</jats:italic> = 0.007). MMP‐8 levels decreased in both groups from baseline to 3 months but increased thereafter, with no significant difference between groups. Conclusion In conclusion, the chitosan brush, when added to mechanical debridement, led to better improvement in BoP compared to ultrasonic scaling alone, but did not show superior results for other clinical parameters or MMP‐8 levels. Clinical Trial Registration The trial is registered at the US National Library of Medicine ClinicalTrials.gov (NCT06127069). Plain Language Summary After periodontal therapy, patients with periodontitis may still have persistent periodontal pockets with bleeding on probing, indicating ongoing inflammation. However, retreating these pockets can be unpredictable. This study investigated the effectiveness of a new chitosan brush for treating these pockets. Results showed that its use did not improve all clinical parameters, but significantly reduced bleeding—indicating less inflammation—at the treated sites 6 months after therapy. The absence of bleeding is crucial in preventing disease progression. Maintaining clinically healthy sites during the maintenance phase is essential for long‐term positive outcomes and helps reduce the risk of further gum disease progression.","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"28 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461283","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 Numerous studies have reported an association between depression and periodontitis, though results are inconsistent and highly heterogeneous. The present study aimed to examine the potential confounding role of poor socioeconomic status (SES) in the association between depression and periodontitis by performing a secondary analysis of the National Health and Nutrition Examination Survey (NHANES) data. Methods Among participants of the 2009–2014 NHANES cycles, those who fulfilled sociodemographic (education level, household income, ethnicity, marital status), medical, and depression questionnaires, and underwent full‐mouth periodontal examination were selected. Periodontitis (mild, moderate, and severe) was assessed based on the Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) criteria. Depression was defined by a Patient Health Questionnaire (PHQ‐9) total score ≥10. Weighted multivariable regressions for complex design models were used to assess the association between periodontitis and depression accounting for the role of SES. Adjusted odds ratio (OR) with 95% confidence intervals (CIs) were provided. Results Among 9537 participants [mean age: 51.9 years (SD: 14.1), 50.1% females], 4768 (41.2%) and 830 (7.3%) presented with periodontitis and depression, respectively. Depression was significantly associated with periodontitis (weighted OR [95% CI]: 1.26 [1.01–1.56]). However, this association was no longer significant when adjusting for SES indicators (0.94 [0.75–1.18]), especially poverty (91.4% of OR reduction when adjusting for poverty only). Conclusion The association between depression and periodontitis may largely be explained by SES, which should thus be considered at both the population‐ and individual levels in preventive and management strategies. Plain Language Summary Depression and periodontitis are two common health problems, and some studies suggest they might be linked. But could this connection actually be due to other factors, like low income or education levels? To find out, we analyzed data from a national US health survey involving over 9500 adults who answered questions about their mental health, income, education, and lifestyle, and who also underwent a full‐mouth periodontal examination. We found that depression and periodontitis appeared to be connected at first glance. However, when we considered socioeconomic factors—especially low income—the link between the two disappeared. This suggests that financial challenges and limited access to resources might play a bigger role than previously thought. Our findings highlight the need for health professionals to look beyond individual conditions and consider a person's broader life circumstances when providing care. At a public health level, addressing social inequalities could help improve both mental and oral health outcomes.
{"title":"Cross‐sectional analysis of role of socioeconomic status in the association between depression and periodontitis","authors":"Sébastien Jungo, Violaine Smail‐Faugeron, Dominique Guez, Nicolas Hoertel, Cédric Lemogne, Maria‐Clotilde Carra","doi":"10.1002/jper.70012","DOIUrl":"https://doi.org/10.1002/jper.70012","url":null,"abstract":"Background Numerous studies have reported an association between depression and periodontitis, though results are inconsistent and highly heterogeneous. The present study aimed to examine the potential confounding role of poor socioeconomic status (SES) in the association between depression and periodontitis by performing a secondary analysis of the National Health and Nutrition Examination Survey (NHANES) data. Methods Among participants of the 2009–2014 NHANES cycles, those who fulfilled sociodemographic (education level, household income, ethnicity, marital status), medical, and depression questionnaires, and underwent full‐mouth periodontal examination were selected. Periodontitis (mild, moderate, and severe) was assessed based on the Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) criteria. Depression was defined by a Patient Health Questionnaire (PHQ‐9) total score ≥10. Weighted multivariable regressions for complex design models were used to assess the association between periodontitis and depression accounting for the role of SES. Adjusted odds ratio (OR) with 95% confidence intervals (CIs) were provided. Results Among 9537 participants [mean age: 51.9 years (SD: 14.1), 50.1% females], 4768 (41.2%) and 830 (7.3%) presented with periodontitis and depression, respectively. Depression was significantly associated with periodontitis (weighted OR [95% CI]: 1.26 [1.01–1.56]). However, this association was no longer significant when adjusting for SES indicators (0.94 [0.75–1.18]), especially poverty (91.4% of OR reduction when adjusting for poverty only). Conclusion The association between depression and periodontitis may largely be explained by SES, which should thus be considered at both the population‐ and individual levels in preventive and management strategies. Plain Language Summary Depression and periodontitis are two common health problems, and some studies suggest they might be linked. But could this connection actually be due to other factors, like low income or education levels? To find out, we analyzed data from a national US health survey involving over 9500 adults who answered questions about their mental health, income, education, and lifestyle, and who also underwent a full‐mouth periodontal examination. We found that depression and periodontitis appeared to be connected at first glance. However, when we considered socioeconomic factors—especially low income—the link between the two disappeared. This suggests that financial challenges and limited access to resources might play a bigger role than previously thought. Our findings highlight the need for health professionals to look beyond individual conditions and consider a person's broader life circumstances when providing care. At a public health level, addressing social inequalities could help improve both mental and oral health outcomes.","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"77 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461282","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}
Karina Mendes,Ana T P C Gomes,Dimitris N Tatakis,Tiago Marques,Marla Pinto,Pedro C Lopes,Maria J Correia,Nuno Rosa
BACKGROUNDThe identification of molecular biomarkers that help clinicians in early diagnosis is a key focus of periodontal research. The major aim of this cross-sectional observational study was to assess whether salivary TAM pathway protein levels have the potential to discriminate between periodontally healthy or gingivitis controls and periodontitis patients, including those with mild (I/II) or severe (III/IV) disease.METHODSTwenty-five periodontally healthy, 24 gingivitis, and 51 periodontitis patients further stratified into mild (stages I/II, n = 25) or severe (stages III/IV, n = 26) periodontitis were included. Salivary levels of tyrosine-protein kinase receptor UFO (AXL), TYRO3 protein tyrosine kinase (TYRO3), Proto-oncogene tyrosine-protein kinase MER (MERTK), and growth arrest-specific protein 6 (GAS6) were quantified using a multiplex immunoassay approach.RESULTSSalivary AXL, TYRO3, MERTK, and GAS6 levels were significantly elevated in periodontitis compared to periodontally healthy and gingivitis patients. Similar results for each periodontitis severity subgroup compared to control groups (except for MERTK, which was significantly different only for stage III/IV) were obtained. Supporting these findings, AXL, TYRO3, and GAS6 were the most accurate in differentiating between periodontally healthy/gingivitis and periodontitis, including mild or severe periodontitis (area under the curve [AUC] ranging from 0.72 to 0.89). Overall, combining biomarkers enhanced the predictive value for identifying periodontitis, including mild and severe disease, compared to using individual biomarkers alone (AUC values between 0.81 and 0.91).CONCLUSIONSalivary TAM pathway markers show promise as a potential noninvasive diagnostic screening tool to distinguish between controls (healthy/gingivitis) and periodontitis, including mild or severe periodontitis.PLAIN LANGUAGE SUMMARYSalivary TAM pathway biomarkers can distinguish between periodontally healthy/gingivitis and periodontitis patients, including mild or severe periodontitis.
{"title":"TAM pathway proteins as novel salivary biomarkers for periodontitis.","authors":"Karina Mendes,Ana T P C Gomes,Dimitris N Tatakis,Tiago Marques,Marla Pinto,Pedro C Lopes,Maria J Correia,Nuno Rosa","doi":"10.1002/jper.70021","DOIUrl":"https://doi.org/10.1002/jper.70021","url":null,"abstract":"BACKGROUNDThe identification of molecular biomarkers that help clinicians in early diagnosis is a key focus of periodontal research. The major aim of this cross-sectional observational study was to assess whether salivary TAM pathway protein levels have the potential to discriminate between periodontally healthy or gingivitis controls and periodontitis patients, including those with mild (I/II) or severe (III/IV) disease.METHODSTwenty-five periodontally healthy, 24 gingivitis, and 51 periodontitis patients further stratified into mild (stages I/II, n = 25) or severe (stages III/IV, n = 26) periodontitis were included. Salivary levels of tyrosine-protein kinase receptor UFO (AXL), TYRO3 protein tyrosine kinase (TYRO3), Proto-oncogene tyrosine-protein kinase MER (MERTK), and growth arrest-specific protein 6 (GAS6) were quantified using a multiplex immunoassay approach.RESULTSSalivary AXL, TYRO3, MERTK, and GAS6 levels were significantly elevated in periodontitis compared to periodontally healthy and gingivitis patients. Similar results for each periodontitis severity subgroup compared to control groups (except for MERTK, which was significantly different only for stage III/IV) were obtained. Supporting these findings, AXL, TYRO3, and GAS6 were the most accurate in differentiating between periodontally healthy/gingivitis and periodontitis, including mild or severe periodontitis (area under the curve [AUC] ranging from 0.72 to 0.89). Overall, combining biomarkers enhanced the predictive value for identifying periodontitis, including mild and severe disease, compared to using individual biomarkers alone (AUC values between 0.81 and 0.91).CONCLUSIONSalivary TAM pathway markers show promise as a potential noninvasive diagnostic screening tool to distinguish between controls (healthy/gingivitis) and periodontitis, including mild or severe periodontitis.PLAIN LANGUAGE SUMMARYSalivary TAM pathway biomarkers can distinguish between periodontally healthy/gingivitis and periodontitis patients, including mild or severe periodontitis.","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"61 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145440589","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}
Bruno Courtois,Arnaud L'Homme,Marie-Pierre Labadie
BACKGROUNDThere is demand for new biomaterials that reduce the morbidity associated with a second graft site needed for autologous bone grafting and facilitate the surgical procedure. Here we compared bone volume gain using a supercritical CO2-processed allogeneic bone paste and bone powder in partially edentulous patients requiring bone augmentation of alveolar ridges by guided bone regeneration (GBR) to place one or more implants.METHODSEighty-six patients with bone defects requiring horizontal and/or vertical bone augmentation were randomly assigned to receive allogeneic bone paste or bone powder for GBR. The primary outcome was horizontal bone gain at implant placement measured by cone-beam computed tomography (CBCT) 4-6 months post grafting. Secondary outcomes were ease of graft manipulation, surgery duration, absolute bone gain, peri-implant marginal bone height, implant survival, and complications.RESULTSOf 42 bone paste patients receiving 51 implants and 40 bone powder patients receiving 53 implants analyzed per protocol, 38% and 72% achieved horizontal bone gain corresponding to the desired pregraft bone volume, respectively (p < 0.001). Both groups showed stable bone gain during initial healing and after implant placement, with 88.6% and 90.6% of implants maintained in the bone paste and bone powder groups at study completion, respectively (p = 0.43). Six implants were lost in the bone paste group and five in the bone powder group.CONCLUSIONSSupercritical CO2-processed bone paste allografts are safe, augment bone, and result in acceptable implant survival for alveolar ridge augmentation by GBR. However, suboptimal material properties due to the viscoelastic consistency of the bone paste resulted in significantly less bone gain than bone powder, which will guide the choice of material clinically.CLINICAL TRIAL REGISTRATIONThe trial is registered at the US National Library ClinicalTrials.gov (NCT04141215).PLAIN LANGUAGE SUMMARYThis first randomized controlled trial of supercritical CO2-processed bone paste allografts confirms their safety, adequate bone augmentation, and implant survival, but inadequate mechanical strength resulted in significantly less bone gain than with bone powder.
{"title":"Allogeneic bone paste versus bone powder for oral guided bone regeneration: A randomized, noninferiority trial.","authors":"Bruno Courtois,Arnaud L'Homme,Marie-Pierre Labadie","doi":"10.1002/jper.11385","DOIUrl":"https://doi.org/10.1002/jper.11385","url":null,"abstract":"BACKGROUNDThere is demand for new biomaterials that reduce the morbidity associated with a second graft site needed for autologous bone grafting and facilitate the surgical procedure. Here we compared bone volume gain using a supercritical CO2-processed allogeneic bone paste and bone powder in partially edentulous patients requiring bone augmentation of alveolar ridges by guided bone regeneration (GBR) to place one or more implants.METHODSEighty-six patients with bone defects requiring horizontal and/or vertical bone augmentation were randomly assigned to receive allogeneic bone paste or bone powder for GBR. The primary outcome was horizontal bone gain at implant placement measured by cone-beam computed tomography (CBCT) 4-6 months post grafting. Secondary outcomes were ease of graft manipulation, surgery duration, absolute bone gain, peri-implant marginal bone height, implant survival, and complications.RESULTSOf 42 bone paste patients receiving 51 implants and 40 bone powder patients receiving 53 implants analyzed per protocol, 38% and 72% achieved horizontal bone gain corresponding to the desired pregraft bone volume, respectively (p < 0.001). Both groups showed stable bone gain during initial healing and after implant placement, with 88.6% and 90.6% of implants maintained in the bone paste and bone powder groups at study completion, respectively (p = 0.43). Six implants were lost in the bone paste group and five in the bone powder group.CONCLUSIONSSupercritical CO2-processed bone paste allografts are safe, augment bone, and result in acceptable implant survival for alveolar ridge augmentation by GBR. However, suboptimal material properties due to the viscoelastic consistency of the bone paste resulted in significantly less bone gain than bone powder, which will guide the choice of material clinically.CLINICAL TRIAL REGISTRATIONThe trial is registered at the US National Library ClinicalTrials.gov (NCT04141215).PLAIN LANGUAGE SUMMARYThis first randomized controlled trial of supercritical CO2-processed bone paste allografts confirms their safety, adequate bone augmentation, and implant survival, but inadequate mechanical strength resulted in significantly less bone gain than with bone powder.","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"134 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380996","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}
BACKGROUNDEmerging evidence indicates that oral health and metabolic dysfunction-associated steatotic liver disease (MASLD) may be interconnected through shared genetic and metabolic pathways. However, the specific mechanisms underlying this association remains poorly understood.METHODSThis population-based study included 478,000 participants from the UK Biobank (mean age: 56.5 years; 54.4% females). The Oral Health Score (OHS) and Periodontal Disease Risk (PDR) Index were developed from six baseline oral health symptoms to evaluate the combined effects of oral health on MASLD risk. Mediation analysis was conducted to investigate potential nutrition-metabolism pathways involving 142 metabolic factors. A Polygenic Risk Score (PRS) was constructed to assess the joint impact and potential interactions between oral health and genetic susceptibility on MASLD risk.RESULTSDuring a median follow-up of 13.2 years, 6980 MASLD cases were ascertained. Painful gums showed the strongest association with MASLD risk among six oral symptoms (hazard ratio [HR]: 1.42, 95% confidence interval [CI]: 1.28-1.58, p = 1.51 × 10-10). Poor oral health was associated with a 60% increased MASLD risk (HR: 1.60, 95% CI: 1.42-1.80, p = 1.13 × 10-14), while PDR index indicated an 18% increase (HR: 1.18, 95% CI: 1.11-1.25, p = 2.31 × 10-8). Several metabolomic pathways-particularly those involving very low-density lipoproteins, fatty acids, and triglycerides-significantly mediated the association, explaining up to 19.4% of the relationship. Across genetic risk strata, both OHS and PDR remained independently associated with MASLD incidence (HR range: 1.28-3.68).CONCLUSIONPoor oral health and periodontal disease may contribute to an increased risk of MASLD by regulating the metabolic milieu, independently of genetic predisposition. As a modifiable and nutritionally relevant factor, oral health represents a promising target for early MASLD prevention. Integrating dental and metabolic care through a multidisciplinary approach could improve liver outcomes by modulating the oral-gut-liver axis.KEY POINTSInvestigated the association between oral health and metabolic dysfunction-associated steatotic liver disease (MASLD) in a 13-year prospective cohort of ∼0.5 million individuals. Explored the potential mediating roles of 142 circulating metabolic biomarkers. Assessed the modifying role of genetic susceptibility in the oral health-MASLD link. Provided novel evidence supporting the oral-gut-liver axis in metabolic disease.PLAIN LANGUAGE SUMMARYIn this study, nearly half a million UK Biobank participants were followed over 13 years to investigate the association between oral health and liver disease. Poor oral health and periodontal disease were associated with an increased risk of developing metabolic dysfunction-associated steatotic liver disease (MASLD), a common chronic liver condition. Further analyses suggest that genetic susceptibility and metabolic alterations may underlie this ass
背景：越来越多的证据表明，口腔健康和代谢功能障碍相关的脂肪变性肝病（MASLD）可能通过共享的遗传和代谢途径相互关联。然而，这种关联背后的具体机制仍然知之甚少。方法：这项基于人群的研究包括来自英国生物银行的478,000名参与者（平均年龄：56.5岁，54.4%为女性）。口腔健康评分（OHS）和牙周病风险指数（PDR）从六个基线口腔健康症状发展，以评估口腔健康对MASLD风险的综合影响。通过中介分析，探讨涉及142个代谢因子的潜在营养代谢途径。构建多基因风险评分（PRS）来评估口腔健康和遗传易感性对MASLD风险的共同影响和潜在相互作用。结果在中位随访13.2年期间，确定了6980例MASLD病例。在6种口腔症状中，牙龈疼痛与MASLD风险的相关性最强（风险比[HR]: 1.42, 95%可信区间[CI]: 1.28-1.58, p = 1.51 × 10-10）。口腔健康状况不佳与MASLD风险增加60%相关（HR: 1.60, 95% CI: 1.42-1.80, p = 1.13 × 10-14），而PDR指数显示增加18% （HR: 1.18, 95% CI: 1.11-1.25, p = 2.31 × 10-8）。几种代谢组学途径——特别是那些涉及极低密度脂蛋白、脂肪酸和甘油三酯的代谢组学途径——显著地介导了这种关联，解释了高达19.4%的关系。在遗传风险层中，OHS和PDR仍与MASLD发病率独立相关（HR范围：1.28-3.68）。结论口腔健康状况不佳和牙周病可能通过调节代谢环境而增加MASLD的风险，而不依赖于遗传易感性。作为一个可改变的和营养相关的因素，口腔健康是早期预防MASLD的一个有希望的目标。通过多学科方法整合牙科和代谢护理可以通过调节口腔-肠-肝轴改善肝脏预后。在一项为期13年、约50万人的前瞻性队列研究中，研究了口腔健康与代谢功能障碍相关的脂肪变性肝病（MASLD）之间的关系。探索142种循环代谢生物标志物的潜在介导作用。评估遗传易感性在口腔健康- masld联系中的调节作用。为代谢性疾病的口腔-肠-肝轴提供了新的证据。在这项研究中，近50万英国生物银行的参与者被跟踪了13年，以调查口腔健康和肝脏疾病之间的关系。口腔健康状况不佳和牙周病与代谢功能障碍相关的脂肪变性肝病（MASLD）（一种常见的慢性肝病）发生风险增加相关。进一步的分析表明，遗传易感性和代谢改变可能是这种关联的基础。这些发现强调了口腔、肠道和肝脏的相互联系，并强调了保持良好口腔健康的潜在全身益处。
{"title":"Genetic susceptibility and metabolic pathways linking oral health to metabolic dysfunction-associated steatotic liver disease.","authors":"Xinjian Ye,Bin Liu,Zhihuan Liu,Tao Zheng,Yihao Fan,Jie Ni,Qifei Ge,Zhiyong Wang,Qianming Chen,Yingying Mao","doi":"10.1002/jper.70029","DOIUrl":"https://doi.org/10.1002/jper.70029","url":null,"abstract":"BACKGROUNDEmerging evidence indicates that oral health and metabolic dysfunction-associated steatotic liver disease (MASLD) may be interconnected through shared genetic and metabolic pathways. However, the specific mechanisms underlying this association remains poorly understood.METHODSThis population-based study included 478,000 participants from the UK Biobank (mean age: 56.5 years; 54.4% females). The Oral Health Score (OHS) and Periodontal Disease Risk (PDR) Index were developed from six baseline oral health symptoms to evaluate the combined effects of oral health on MASLD risk. Mediation analysis was conducted to investigate potential nutrition-metabolism pathways involving 142 metabolic factors. A Polygenic Risk Score (PRS) was constructed to assess the joint impact and potential interactions between oral health and genetic susceptibility on MASLD risk.RESULTSDuring a median follow-up of 13.2 years, 6980 MASLD cases were ascertained. Painful gums showed the strongest association with MASLD risk among six oral symptoms (hazard ratio [HR]: 1.42, 95% confidence interval [CI]: 1.28-1.58, p = 1.51 × 10-10). Poor oral health was associated with a 60% increased MASLD risk (HR: 1.60, 95% CI: 1.42-1.80, p = 1.13 × 10-14), while PDR index indicated an 18% increase (HR: 1.18, 95% CI: 1.11-1.25, p = 2.31 × 10-8). Several metabolomic pathways-particularly those involving very low-density lipoproteins, fatty acids, and triglycerides-significantly mediated the association, explaining up to 19.4% of the relationship. Across genetic risk strata, both OHS and PDR remained independently associated with MASLD incidence (HR range: 1.28-3.68).CONCLUSIONPoor oral health and periodontal disease may contribute to an increased risk of MASLD by regulating the metabolic milieu, independently of genetic predisposition. As a modifiable and nutritionally relevant factor, oral health represents a promising target for early MASLD prevention. Integrating dental and metabolic care through a multidisciplinary approach could improve liver outcomes by modulating the oral-gut-liver axis.KEY POINTSInvestigated the association between oral health and metabolic dysfunction-associated steatotic liver disease (MASLD) in a 13-year prospective cohort of ∼0.5 million individuals. Explored the potential mediating roles of 142 circulating metabolic biomarkers. Assessed the modifying role of genetic susceptibility in the oral health-MASLD link. Provided novel evidence supporting the oral-gut-liver axis in metabolic disease.PLAIN LANGUAGE SUMMARYIn this study, nearly half a million UK Biobank participants were followed over 13 years to investigate the association between oral health and liver disease. Poor oral health and periodontal disease were associated with an increased risk of developing metabolic dysfunction-associated steatotic liver disease (MASLD), a common chronic liver condition. Further analyses suggest that genetic susceptibility and metabolic alterations may underlie this ass","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"1 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380999","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}
Yousef T Amrou,Abdusalam E Alrmali,Hamzeh Almashni,Pablo Galindo-Fernandez,Hom-Lay Wang,Muhammad H A Saleh
BACKGROUNDDirect comparative data on periodontal regeneration (PR) versus extraction and implant placement remain limited. Tooth-specific periodontal conditions such as furcation involvement and overall tooth prognosis may dictate success or failure of such treatment.METHODSA retrospective analysis was conducted on patients undergoing periodontal regenerative procedures or dental implants at the University of Michigan periodontics clinics. Clinical outcomes were assessed, including tooth and implant survival, success rates, and complications. Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio (ICER).RESULTSIn a cohort of 130 subjects (176 sites; 88 PR-treated teeth and 88 implants; mean age 63.7 ± 12.7 years) followed for 6.4 years on average, no differences in survival or success rates were found (odds ratio [OR] = 0.36, p = 0.2, and OR = 0.77, p = 0.56, respectively). In the PR group, a one-wall defect and ≥1 furcation involvement (FI) increased the risk of tooth loss by approximately fourfold, while Periodontal Risk Scores (PRSs) of 2 and 3 were associated with 22- to 35-fold greater risk than PRS1 (p < 0.05). "The total complication rate in the implant group was 26.1%, largely due to peri-implantitis (PI), compared to 9.1% in the PR group (OR = 3.54, p = 0.006)." Kaplan-Meier analysis revealed mean survival times of 9.3 years for PR and 12.65 years for implants. Implant cost-effectiveness depended on initial tooth prognosis and FI, with a 60% reduction in ICER per additional year ($187) compared to teeth with a good prognosis (PRS1).CONCLUSIONBoth PR and dental implant treatments achieved comparable long-term survival and success rates. Cost considerations suggest personalized treatment decisions based on individual periodontal conditions like FI and overall tooth prognosis.PLAIN LANGUAGE SUMMARYThis study compared the long-term outcomes and cost-effectiveness of 2 approaches-periodontal regeneration to preserve teeth versus dental implants to replace them-in patients with advanced periodontitis. The analysis found that both treatments generally achieved similar survival and success rates. However, implants tended to have more complications, especially due to peri-implantitis, while teeth with certain conditions, like molars with advanced furcation involvement or higher periodontal risk scores, were more likely to be lost over time. Although no clear cost-effectiveness advantage emerged for either approach, the findings emphasize that initial tooth health and other specific conditions significantly influence outcomes. Therefore, personalized treatment decisions considering the patient's unique periodontal situation may help improve both clinical results and cost efficiency.
背景：牙周再生（PR）与拔牙和种植体放置的直接比较数据仍然有限。牙齿特定的牙周状况，如分叉受累和整体牙齿预后可能决定这种治疗的成功或失败。方法回顾性分析在密歇根大学牙周病诊所接受牙周再生手术或种植牙的患者。评估临床结果，包括牙齿和种植体存活、成功率和并发症。使用增量成本-效果比（ICER）评估成本-效果。结果130例患者（176个部位，88颗pr处理牙和88颗种植体，平均年龄63.7±12.7岁）平均随访6.4年，生存率和成功率无差异（优势比[or] = 0.36, p = 0.2; or = 0.77, p = 0.56）。在PR组中，单壁缺损和≥1个分叉累及（FI）使牙齿脱落的风险增加了约4倍，而牙周风险评分（PRSs）为2和3的风险比PRS1高22至35倍（p < 0.05）。“种植体组的总并发症发生率为26.1%，主要是由于种植体周围炎（PI），而PR组为9.1% （OR = 3.54, p = 0.006）。”Kaplan-Meier分析显示PR的平均生存时间为9.3年，植入物的平均生存时间为12.65年。种植体的成本效益取决于初始牙齿预后和FI，与预后良好的牙齿（PRS1）相比，ICER每增加一年减少60%（187美元）。结论PR治疗与种植牙治疗的远期生存率和成功率相当。考虑到成本因素，建议根据个人牙周状况（如FI）和整体牙齿预后做出个性化治疗决定。摘要：本研究比较了两种治疗晚期牙周炎患者的长期疗效和成本效益——牙周再生保存牙齿和种植牙替代牙齿。分析发现，两种治疗方法的存活率和成功率大致相当。然而，种植体往往有更多的并发症，特别是由于种植体周围炎，而某些情况下的牙齿，如臼齿分岔累及或牙周风险评分较高，更有可能随着时间的推移而丢失。尽管两种方法都没有明显的成本效益优势，但研究结果强调，初始牙齿健康和其他特定条件对结果有显著影响。因此，考虑到患者独特的牙周情况的个性化治疗决定可能有助于改善临床结果和成本效率。
{"title":"Cost-effectiveness and long-term outcomes of periodontal regeneration versus dental implants: A retrospective study.","authors":"Yousef T Amrou,Abdusalam E Alrmali,Hamzeh Almashni,Pablo Galindo-Fernandez,Hom-Lay Wang,Muhammad H A Saleh","doi":"10.1002/jper.70023","DOIUrl":"https://doi.org/10.1002/jper.70023","url":null,"abstract":"BACKGROUNDDirect comparative data on periodontal regeneration (PR) versus extraction and implant placement remain limited. Tooth-specific periodontal conditions such as furcation involvement and overall tooth prognosis may dictate success or failure of such treatment.METHODSA retrospective analysis was conducted on patients undergoing periodontal regenerative procedures or dental implants at the University of Michigan periodontics clinics. Clinical outcomes were assessed, including tooth and implant survival, success rates, and complications. Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio (ICER).RESULTSIn a cohort of 130 subjects (176 sites; 88 PR-treated teeth and 88 implants; mean age 63.7 ± 12.7 years) followed for 6.4 years on average, no differences in survival or success rates were found (odds ratio [OR] = 0.36, p = 0.2, and OR = 0.77, p = 0.56, respectively). In the PR group, a one-wall defect and ≥1 furcation involvement (FI) increased the risk of tooth loss by approximately fourfold, while Periodontal Risk Scores (PRSs) of 2 and 3 were associated with 22- to 35-fold greater risk than PRS1 (p < 0.05). \"The total complication rate in the implant group was 26.1%, largely due to peri-implantitis (PI), compared to 9.1% in the PR group (OR = 3.54, p = 0.006).\" Kaplan-Meier analysis revealed mean survival times of 9.3 years for PR and 12.65 years for implants. Implant cost-effectiveness depended on initial tooth prognosis and FI, with a 60% reduction in ICER per additional year ($187) compared to teeth with a good prognosis (PRS1).CONCLUSIONBoth PR and dental implant treatments achieved comparable long-term survival and success rates. Cost considerations suggest personalized treatment decisions based on individual periodontal conditions like FI and overall tooth prognosis.PLAIN LANGUAGE SUMMARYThis study compared the long-term outcomes and cost-effectiveness of 2 approaches-periodontal regeneration to preserve teeth versus dental implants to replace them-in patients with advanced periodontitis. The analysis found that both treatments generally achieved similar survival and success rates. However, implants tended to have more complications, especially due to peri-implantitis, while teeth with certain conditions, like molars with advanced furcation involvement or higher periodontal risk scores, were more likely to be lost over time. Although no clear cost-effectiveness advantage emerged for either approach, the findings emphasize that initial tooth health and other specific conditions significantly influence outcomes. Therefore, personalized treatment decisions considering the patient's unique periodontal situation may help improve both clinical results and cost efficiency.","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"7 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380997","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}
María Martínez,David Fraguas,Elena Figuero,Francesco D Aiuto
BACKGROUNDPeriodontitis and major depression disorder have been shown to have a bidirectional association. However, the impact of antidepressants, the primary pharmacological treatment for depression, on periodontal health remains unclear. Given their anti-inflammatory properties, antidepressants may exert a protective effect against periodontitis. This study aimed to investigate the association between antidepressant use and the prevalence of periodontitis in a large, nationally representative sample of the United States (US) population.METHODSData from the National Health and Nutrition Examination Survey (NHANES) 2009-2014 were analyzed. Antidepressant use was recorded using the Dietary Supplement and Prescription Medication section of the Sample Person Questionnaire. Periodontal status was assessed through full-mouth evaluations of gingival recession and probing pocket depth. Adjusted odds ratios (ORs) were calculated using multiple logistic regression models to evaluate the association between antidepressant use and periodontitis, adjusting for confounders.RESULTSAmong 9839 participants, which prevalence of periodontitis was 35.3% for moderate and 11.1% for severe cases, according to American Academy of Pediatrics/Centers for Disease Control and Prevention (AAP/CDC) classification, antidepressant use was associated with reduced odds of developing periodontitis across most definitions, particularly in severe cases. For advanced periodontitis (stages III-IV), the adjusted OR was 0.68 (95% confidence interval [CI]: 0.54-0.86), and for severe periodontitis per AAP/CDC criteria, the OR was 0.41 (95% CI: 0.26-0.66).CONCLUSIONAntidepressant use is linked to a lower prevalence of periodontitis, with a more pronounced protective effect in severe cases. These findings suggest plausible beneficial role of antidepressants on periodontitis, warranting further investigation into the underlying mechanisms.PLAIN LANGUAGE SUMMARYAntidepressant medications are widely used to treat depression. Given their anti-inflammatory properties, their protective role on inflammatory conditions such as periodontitis deserves to be further explored. Therefore, the aim of this study was to investigate the association between antidepressant use and the prevalence of periodontitis in a large, nationally representative sample of the United States (US) population. Data from the National Health and Nutrition Examination Survey (NHANES) 2009-2014 were analyzed. Antidepressant use was self-recorded, and periodontal status was assessed through full-mouth dental examination. After adjusting for relevant confounding factors, the analysis revealed that individuals using antidepressants had a lower likelihood of having periodontitis, especially in its severe forms. These findings suggest that antidepressants might play a potential protective role for periodontitis, warranting further investigation into the underlying mechanisms.
{"title":"Reduced prevalence of periodontitis in antidepressant users: Findings from a large-scale US sample.","authors":"María Martínez,David Fraguas,Elena Figuero,Francesco D Aiuto","doi":"10.1002/jper.70014","DOIUrl":"https://doi.org/10.1002/jper.70014","url":null,"abstract":"BACKGROUNDPeriodontitis and major depression disorder have been shown to have a bidirectional association. However, the impact of antidepressants, the primary pharmacological treatment for depression, on periodontal health remains unclear. Given their anti-inflammatory properties, antidepressants may exert a protective effect against periodontitis. This study aimed to investigate the association between antidepressant use and the prevalence of periodontitis in a large, nationally representative sample of the United States (US) population.METHODSData from the National Health and Nutrition Examination Survey (NHANES) 2009-2014 were analyzed. Antidepressant use was recorded using the Dietary Supplement and Prescription Medication section of the Sample Person Questionnaire. Periodontal status was assessed through full-mouth evaluations of gingival recession and probing pocket depth. Adjusted odds ratios (ORs) were calculated using multiple logistic regression models to evaluate the association between antidepressant use and periodontitis, adjusting for confounders.RESULTSAmong 9839 participants, which prevalence of periodontitis was 35.3% for moderate and 11.1% for severe cases, according to American Academy of Pediatrics/Centers for Disease Control and Prevention (AAP/CDC) classification, antidepressant use was associated with reduced odds of developing periodontitis across most definitions, particularly in severe cases. For advanced periodontitis (stages III-IV), the adjusted OR was 0.68 (95% confidence interval [CI]: 0.54-0.86), and for severe periodontitis per AAP/CDC criteria, the OR was 0.41 (95% CI: 0.26-0.66).CONCLUSIONAntidepressant use is linked to a lower prevalence of periodontitis, with a more pronounced protective effect in severe cases. These findings suggest plausible beneficial role of antidepressants on periodontitis, warranting further investigation into the underlying mechanisms.PLAIN LANGUAGE SUMMARYAntidepressant medications are widely used to treat depression. Given their anti-inflammatory properties, their protective role on inflammatory conditions such as periodontitis deserves to be further explored. Therefore, the aim of this study was to investigate the association between antidepressant use and the prevalence of periodontitis in a large, nationally representative sample of the United States (US) population. Data from the National Health and Nutrition Examination Survey (NHANES) 2009-2014 were analyzed. Antidepressant use was self-recorded, and periodontal status was assessed through full-mouth dental examination. After adjusting for relevant confounding factors, the analysis revealed that individuals using antidepressants had a lower likelihood of having periodontitis, especially in its severe forms. These findings suggest that antidepressants might play a potential protective role for periodontitis, warranting further investigation into the underlying mechanisms.","PeriodicalId":16716,"journal":{"name":"Journal of periodontology","volume":"42 1","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145381052","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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