Hamoun Sabri, Muhammad H. A. Saleh, Paolo Nava, Riccardo Scaini, Tiziano Testori, Massimo Del Fabbro
Objectives To quantify long‐term (≥ 5 years) implant survival after lateral sinus floor elevation (LSFE) and to identify clinical predictors of long‐term survival using conventional and machine‐learning meta‐analytic techniques. Methods A systematic search was conducted through MEDLINE, Embase and Scopus. Randomized trials, prospective or retrospective studies with ≥ 10 patients and ≥ 5‐year follow‐up were eligible. Risk of bias was assessed with RoB‐2 (RCTs) and the Newcastle–Ottawa Scale (observational studies); certainty of evidence was graded with GRADE approach. A multilevel random‐effects meta‐analysis (logit‐transformed proportions) estimated pooled survival while accounting for clustering of multiple implants per patient. Moderator effects were explored by mixed‐effects meta‐regression. A MetaForest machine‐learning model examined non‐linear interactions among predictive factors. Results Thirty‐two studies (48 cohorts) involving 7,902 implants and ≈ 2,800 patients met the criteria (3 RCTs, 7 prospective non‐randomized, and 22 retrospective studies; follow‐up 5–13 years). Pooled long‐term survival was 95.8 % (95 % CI: 94.5–96.8 %); Heterogeneity was substantial (I² = 82.8 %) but fell to 53.2 % in MetaForest residuals. Meta‐regression identified lower survival with Graftless procedures versus allografts(β = 1.11, p = 0.016), autografts(β =2.40, p = 0.005), Xenografts(β =1.53, p = 0.04), Xenografts+Allografts(β =1.55, p = 0.04) and Xenografts+Autografts(β =1.82, p = 0.03) with no significant difference versus Alloplasts. Residual bone height (RBH) < 4 mm (β = –0.53, p = 0.039) as well as smoking prevalence (1.96 % per 10 % increase, p = 0.009) reduced survival. MetaForest ranked smoking, age, RBH, follow‐up duration and membrane use as the principal predictors; barrier membranes mitigated the negative effect in smokers and in low‐RBH sites. Time‐to‐failure analysis of 205 failed implants showed 59 % of losses within the first year and 96 % by year 5. Overall certainty of evidence was low. Conclusions Implants placed after LSFE exhibit high 5–13‐year survival (96 %). Use of bone graft materials and their mixtures yield more favorable outcomes compared to Graftless protocol, whereas RBH < 4 mm and smoking significantly impair implant survival. Barrier‐membrane coverage is advisable for smokers and short‐RBH sites. Despite the long‐term nature of this review (≥5 years of follow‐up), most failures occur within the first three years of function, underscoring the need for intensified monitoring during this early phase.
目的量化外侧窦底抬高（LSFE）后种植体的长期（≥5年）生存，并利用传统和机器学习元分析技术确定长期生存的临床预测因素。方法通过MEDLINE、Embase、Scopus进行系统检索。随机试验、前瞻性或回顾性研究≥10例患者和≥5年随访均符合条件。采用RoB‐2 （rct）和Newcastle-Ottawa量表（观察性研究）评估偏倚风险；采用GRADE方法对证据的确定性进行分级。一个多水平随机效应荟萃分析（logit转换比例）在考虑每个患者多个植入物聚类的同时估计了总生存率。通过混合效应meta回归探讨调节效应。metforest机器学习模型检查了预测因素之间的非线性相互作用。32项研究（48个队列）涉及7902个植入物和约2800名患者符合标准（3项随机对照试验，7项前瞻性非随机研究，22项回顾性研究，随访5-13年）。合并长期生存率为95.8% (95% CI: 94.5 - 96.8%)；异质性很大（I²= 82.8%），但在metforest残差中下降到53.2%。Meta回归发现，与同种异体移植（β = 1.11, p = 0.016）、自体移植（β =2.40, p = 0.005）、异种移植（β =1.53, p = 0.04）、异种移植+同种异体移植（β =1.55, p = 0.04）和异种移植+自体移植（β =1.82, p = 0.03）相比，无移植手术的生存率较低，与同种异体移植相比无显著差异。残余骨高度（RBH） 4mm （β = -0.53, p = 0.039）和吸烟率（每增加10%增加1.96%,p = 0.009）降低了生存率。MetaForest将吸烟、年龄、RBH、随访时间和膜使用列为主要预测因素；屏障膜减轻了吸烟者和低RBH部位的负面影响。对205例失败植入物的时间-失效分析显示，59%的植入物在第一年损失，96%的植入物在第5年损失。证据的总体确定性较低。结论：LSFE后植入物具有较高的5-13年生存率（96%）。与Graftless方案相比，骨移植材料及其混合物的使用产生了更有利的结果，而RBH <； 4mm和吸烟显着损害种植体的存活。对于吸烟者和短RBH部位，建议使用屏障膜覆盖。尽管本综述的长期性质（≥5年随访），大多数失败发生在功能的前三年，强调在早期阶段加强监测的必要性。
{"title":"Long‐term outcomes of lateral sinus floor elevation: A machine‐learning analysis, systematic review, and meta‐analysis of predictive factors","authors":"Hamoun Sabri, Muhammad H. A. Saleh, Paolo Nava, Riccardo Scaini, Tiziano Testori, Massimo Del Fabbro","doi":"10.1111/prd.70028","DOIUrl":"https://doi.org/10.1111/prd.70028","url":null,"abstract":"Objectives To quantify long‐term (≥ 5 years) implant survival after lateral sinus floor elevation (LSFE) and to identify clinical predictors of long‐term survival using conventional and machine‐learning meta‐analytic techniques. Methods A systematic search was conducted through MEDLINE, Embase and Scopus. Randomized trials, prospective or retrospective studies with ≥ 10 patients and ≥ 5‐year follow‐up were eligible. Risk of bias was assessed with RoB‐2 (RCTs) and the Newcastle–Ottawa Scale (observational studies); certainty of evidence was graded with GRADE approach. A multilevel random‐effects meta‐analysis (logit‐transformed proportions) estimated pooled survival while accounting for clustering of multiple implants per patient. Moderator effects were explored by mixed‐effects meta‐regression. A MetaForest machine‐learning model examined non‐linear interactions among predictive factors. Results Thirty‐two studies (48 cohorts) involving 7,902 implants and ≈ 2,800 patients met the criteria (3 RCTs, 7 prospective non‐randomized, and 22 retrospective studies; follow‐up 5–13 years). Pooled long‐term survival was 95.8 % (95 % CI: 94.5–96.8 %); Heterogeneity was substantial (I² = 82.8 %) but fell to 53.2 % in MetaForest residuals. Meta‐regression identified lower survival with Graftless procedures versus allografts(β = 1.11, p = 0.016), autografts(β =2.40, p = 0.005), Xenografts(β =1.53, p = 0.04), Xenografts+Allografts(β =1.55, p = 0.04) and Xenografts+Autografts(β =1.82, p = 0.03) with no significant difference versus Alloplasts. Residual bone height (RBH) < 4 mm (β = –0.53, p = 0.039) as well as smoking prevalence (1.96 % per 10 % increase, p = 0.009) reduced survival. MetaForest ranked smoking, age, RBH, follow‐up duration and membrane use as the principal predictors; barrier membranes mitigated the negative effect in smokers and in low‐RBH sites. Time‐to‐failure analysis of 205 failed implants showed 59 % of losses within the first year and 96 % by year 5. Overall certainty of evidence was low. Conclusions Implants placed after LSFE exhibit high 5–13‐year survival (96 %). Use of bone graft materials and their mixtures yield more favorable outcomes compared to Graftless protocol, whereas RBH < 4 mm and smoking significantly impair implant survival. Barrier‐membrane coverage is advisable for smokers and short‐RBH sites. Despite the long‐term nature of this review (≥5 years of follow‐up), most failures occur within the first three years of function, underscoring the need for intensified monitoring during this early phase.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"272 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147507922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ann M. Decker, Sandra H. Stuhr, Gustavo Avila‐Ortiz, Andrea Pilloni, Lorenzo Marini, Rogerio Castilho, Beth I. Wallace, Yvonne L. Hernandez‐Kapila
Objective This narrative synthesizes current knowledge on the biological mechanisms, clinical challenges, and regenerative innovations for optimizing intraoral wound healing in the elderly. Methods Narrative review of preclinical and clinical studies addressing age‐related changes in the four canonical wound‐healing phases (hemostasis, inflammation, proliferation, remodeling), tissue‐specific molecular pathways, systemic and local factors affecting repair, operative considerations, and emerging therapeutic modalities. Data sources included PubMed, Embase, and Cochrane databases through June 2025. Results Aging compromises each repair phase. Hemostasis is prolonged by diminished platelet function and altered clot architecture. Inflammation is exacerbated by impaired neutrophil/phagocyte activity and persistent reactive oxygen species. Proliferation is slowed by reduced fibroblast proliferation and angiogenic signaling, while dysregulated matrix metalloproteinase activity impairs extracellular matrix remodeling. Tissue‐specific cues in oral mucosa, periodontal ligament, cementum, and bone are also altered with age. Compounding factors—including “inflamm‐aging,” malnutrition, polypharmacy‐induced xerostomia, cognitive decline, and frailty—further impede healing. Clinical optimization requires comprehensive preoperative risk and frailty assessments; medical/nutritional management; minimally invasive flap designs; tension‐free primary closure; streamlined surgical protocols to limit operative time; and postoperative monitoring with tailored communication. Emerging regenerative strategies—growth factors (PDGF, FGF), platelet concentrates, gene and cell‐based approaches (MSCs, exosomes), immunomodulatory scaffolds/agents, photobiomodulation, and AI‐driven risk dashboards—show promise for enhancing repair in aging populations. Conclusions Effective oral wound healing in older adults demands a multidisciplinary, personalized approach that integrates meticulous perioperative care with novel regenerative modalities. Standardization and clinical validation of emerging therapies are essential to translate biological insights into improved patient outcomes.
{"title":"Oral wound healing in the elderly: Mechanisms, challenges, and innovations","authors":"Ann M. Decker, Sandra H. Stuhr, Gustavo Avila‐Ortiz, Andrea Pilloni, Lorenzo Marini, Rogerio Castilho, Beth I. Wallace, Yvonne L. Hernandez‐Kapila","doi":"10.1111/prd.70027","DOIUrl":"https://doi.org/10.1111/prd.70027","url":null,"abstract":"Objective This narrative synthesizes current knowledge on the biological mechanisms, clinical challenges, and regenerative innovations for optimizing intraoral wound healing in the elderly. Methods Narrative review of preclinical and clinical studies addressing age‐related changes in the four canonical wound‐healing phases (hemostasis, inflammation, proliferation, remodeling), tissue‐specific molecular pathways, systemic and local factors affecting repair, operative considerations, and emerging therapeutic modalities. Data sources included PubMed, Embase, and Cochrane databases through June 2025. Results Aging compromises each repair phase. Hemostasis is prolonged by diminished platelet function and altered clot architecture. Inflammation is exacerbated by impaired neutrophil/phagocyte activity and persistent reactive oxygen species. Proliferation is slowed by reduced fibroblast proliferation and angiogenic signaling, while dysregulated matrix metalloproteinase activity impairs extracellular matrix remodeling. Tissue‐specific cues in oral mucosa, periodontal ligament, cementum, and bone are also altered with age. Compounding factors—including “inflamm‐aging,” malnutrition, polypharmacy‐induced xerostomia, cognitive decline, and frailty—further impede healing. Clinical optimization requires comprehensive preoperative risk and frailty assessments; medical/nutritional management; minimally invasive flap designs; tension‐free primary closure; streamlined surgical protocols to limit operative time; and postoperative monitoring with tailored communication. Emerging regenerative strategies—growth factors (PDGF, FGF), platelet concentrates, gene and cell‐based approaches (MSCs, exosomes), immunomodulatory scaffolds/agents, photobiomodulation, and AI‐driven risk dashboards—show promise for enhancing repair in aging populations. Conclusions Effective oral wound healing in older adults demands a multidisciplinary, personalized approach that integrates meticulous perioperative care with novel regenerative modalities. Standardization and clinical validation of emerging therapies are essential to translate biological insights into improved patient outcomes.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"18 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147507927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ignacio Sanz Sánchez, Maria Clotilde Carra, Ana Carrillo de Albornoz, Mario Romandini, Eduardo Montero, Mariano Sanz
Background Non‐surgical periodontal therapy (NSPT) remains the fundamental approach in periodontal treatment and has been extensively studied over the past decades. Evidence consistently shows that NSPT exerts a substantial and sustained impact on tooth retention and on key surrogate outcomes, including gains in clinical attachment levels, reductions in probing pocket depths and improvements in inflammatory parameters. Aim To evaluate the long‐term (≥5 years) efficacy of non‐surgical periodontal therapy and to explore the effect of alternative or adjunctive mechanical methods (e.g., laser, air‐polishing devices, etc.) compared to hand, sonic, or ultrasonic instruments in NSPT. Material and Methods A systematic electronic search was conducted to analyse the scientific literature available by including all potential studies reporting long‐term results of the non‐surgical periodontal treatment, regardless of study design. To evaluate the effectiveness of alternative protocols for subgingival instrumentation, a systematic electronic sear was also conducted including only randomized clinical trials (RCTs). Results 27 manuscripts corresponding to 20 investigations reported on the long‐term outcomes of non‐surgical therapy. Most of the studies showed low incidence of tooth loss, clinical attachment gains at initially deep pockets and probing pocket depth reductions, especially on those patients attending regularly supportive periodontal care (SPC). The use of laser as an alternative to hand instruments or ultrasonic devices, or as adjuncts to subgingival instrumentation has shown conflictive results. Some studies evaluating the adjunctive use of antimicrobial photodynamic therapy have reported modest clinical improvements in the short term (3 to 6 months). Subgingival air‐polishing may offer potential benefits for patient comfort and shorter treatment times. Conclusions Overall, the available evidence supports NSPT as a reliable and long‐lasting treatment option, while emphasizing the need for further research on patient reported outcomes and systemic effects within the long‐term framework of comprehensive periodontal treatment. Clinical Relevance Non‐surgical periodontal therapy is the key tool for treating periodontitis in most patients. The gold standard treatment is subgingival instrumentation using hand‐ or power‐driven instruments, together with regular SPC. Various alternative or adjunctive therapies have been suggested, but the evidence available is limited, particularly in the long term.
{"title":"Long‐term stability after nonsurgical treatment of periodontitis","authors":"Ignacio Sanz Sánchez, Maria Clotilde Carra, Ana Carrillo de Albornoz, Mario Romandini, Eduardo Montero, Mariano Sanz","doi":"10.1111/prd.70032","DOIUrl":"https://doi.org/10.1111/prd.70032","url":null,"abstract":"Background Non‐surgical periodontal therapy (NSPT) remains the fundamental approach in periodontal treatment and has been extensively studied over the past decades. Evidence consistently shows that NSPT exerts a substantial and sustained impact on tooth retention and on key surrogate outcomes, including gains in clinical attachment levels, reductions in probing pocket depths and improvements in inflammatory parameters. Aim To evaluate the long‐term (≥5 years) efficacy of non‐surgical periodontal therapy and to explore the effect of alternative or adjunctive mechanical methods (e.g., laser, air‐polishing devices, etc.) compared to hand, sonic, or ultrasonic instruments in NSPT. Material and Methods A systematic electronic search was conducted to analyse the scientific literature available by including all potential studies reporting long‐term results of the non‐surgical periodontal treatment, regardless of study design. To evaluate the effectiveness of alternative protocols for subgingival instrumentation, a systematic electronic sear was also conducted including only randomized clinical trials (RCTs). Results 27 manuscripts corresponding to 20 investigations reported on the long‐term outcomes of non‐surgical therapy. Most of the studies showed low incidence of tooth loss, clinical attachment gains at initially deep pockets and probing pocket depth reductions, especially on those patients attending regularly supportive periodontal care (SPC). The use of laser as an alternative to hand instruments or ultrasonic devices, or as adjuncts to subgingival instrumentation has shown conflictive results. Some studies evaluating the adjunctive use of antimicrobial photodynamic therapy have reported modest clinical improvements in the short term (3 to 6 months). Subgingival air‐polishing may offer potential benefits for patient comfort and shorter treatment times. Conclusions Overall, the available evidence supports NSPT as a reliable and long‐lasting treatment option, while emphasizing the need for further research on patient reported outcomes and systemic effects within the long‐term framework of comprehensive periodontal treatment. Clinical Relevance Non‐surgical periodontal therapy is the key tool for treating periodontitis in most patients. The gold standard treatment is subgingival instrumentation using hand‐ or power‐driven instruments, together with regular SPC. Various alternative or adjunctive therapies have been suggested, but the evidence available is limited, particularly in the long term.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"8 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147507924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhammad H. A. Saleh, Abdusalam E. Alrmali, Fatemeh SamavatiJame, Hamzeh Almanshi, Shahad Alhazmi, Sawsan Abo‐Reyal, Hom‐Lay Wang, Ann Decker
Background Periodontal clinical trials commonly use surrogate end points (e.g., probing pocket depth [PPD], clinical attachment level [CAL], bleeding on probing [BoP], and composite scores such as the Periodontal Risk Score [PRS]) for efficiency, yet tooth loss, treatment burden/cost, and re‐treatment are the definitive patient‐relevant measures of long‐term success. Methods This mixed‐methods study evaluated the predictive performance of three surrogate definitions and contextualized the findings with a 50‐year narrative review of longitudinal evidence linking PPD, CAL, and BoP to tooth retention. Additionally, a retrospective cohort (2001–2024) of 160 patients (919 teeth) treated at the University of Michigan was studied. Each participant had baseline PPD ≥6 mm after initial therapy (sites nonresponsive to initial nonsurgical therapy) and received up to 20 years of supportive periodontal therapy (SPT) following active periodontal therapy (APT). Three surrogate definitions: TEP A (no pockets ≥6 mm), TEP B (pockets ≤4 mm without BoP), and the PRS were compared against two true end points: tooth loss due to periodontitis (TLP) and need for additional therapy (re‐treatment). Logistic regression with generalized estimating equations was used to estimate sensitivity, specificity, positive/negative predictive values, and area under the curve (AUC). Results Overall, tooth loss was 28.4%, with 18.9% due to periodontitis. Additional treatment was required by 91.5% of patients. For TLP, TEP‐B provided the highest sensitivity, whereas PRS = 3 provided the highest specificity and positive predictive value (AUC = 0.556, p = 0.021). PRS ≥2 showed the best overall discrimination/accuracy for TLP (AUC = 0.637, p < 0.001). TEP‐A and TEP‐B demonstrated modest discrimination (AUC = 0.567, p < 0.007 and AUC = 0.549, p = 0.047, respectively). For re‐treatment, TEP‐B yielded 82.2% sensitivity, and PRS = 3 demonstrated 96.6% specificity (PPV = 96.8%); PRS ≥2 alone achieved AUC = 0.625 ( p = 0.033), while no significant differences were observed among the remaining models. Conclusions For practical application, baseline risk stratification can be performed using PRS ≥2 to support early screening for periodontitis‐related tooth loss, while PRS = 3 can be reserved for high‐confidence confirmation when minimizing false positives is critical. During postsurgical follow‐up after APT and throughout SPT, TEP‐B (PPD ≤4 mm with no BoP) can be used as the primary monitoring target to flag likely instability and identify teeth likely to require re‐treatment, whereas PRS = 3 can be applied to guide final treatment decisions or resource‐intensive interventions.
牙周临床试验通常使用替代终点（例如，探牙袋深度[PPD]、临床附着水平[CAL]、探牙出血[BoP]和牙周风险评分[PRS]等综合评分）来衡量效率，但牙齿脱落、治疗负担/成本和再治疗是与患者相关的长期成功的最终衡量标准。方法：该混合方法研究评估了三种替代定义的预测性能，并将研究结果与50年来PPD、CAL和BoP与牙齿固位之间的纵向证据联系起来。此外，对在密歇根大学接受治疗的160名患者（919颗牙齿）的回顾性队列（2001-2024）进行了研究。每位参与者在初始治疗（对初始非手术治疗无反应的部位）后的基线PPD≥6 mm，并在积极牙周治疗（APT）后接受长达20年的支持性牙周治疗（SPT）。三个替代定义：TEP A（无袋≥6mm）， TEP B（袋≤4mm，无BoP），以及PRS与两个真实终点：牙周炎引起的牙齿脱落（TLP）和需要额外治疗（再治疗）进行比较。采用广义估计方程的Logistic回归来估计敏感性、特异性、阳性/阴性预测值和曲线下面积（AUC）。结果牙周脱落占28.4%，牙周炎占18.9%。91.5%的患者需要额外治疗。对于TLP， TEP‐B具有最高的敏感性，而PRS = 3具有最高的特异性和阳性预测值（AUC = 0.556, p = 0.021）。PRS≥2对TLP的总体鉴别/准确度最好（AUC = 0.637, p < 0.001）。TEP‐A和TEP‐B表现出适度的区分（AUC = 0.567, p <； 0.007和AUC = 0.549, p = 0.047）。对于再处理，TEP‐B的敏感性为82.2%,PRS = 3的特异性为96.6% (PPV = 96.8%)；单独PRS≥2的AUC = 0.625 (p = 0.033)，其余模型间无显著差异。在实际应用中，基线风险分层可以使用PRS≥2来支持牙周炎相关牙齿脱落的早期筛查，而PRS = 3可以保留用于高置信度的确认，当最大限度地减少假阳性是至关重要的。在APT术后随访和整个SPT期间，TEP - B （PPD≤4 mm，无BoP）可作为主要监测目标，标记可能的不稳定并识别可能需要重新治疗的牙齿，而PRS = 3可用于指导最终治疗决策或资源密集型干预。
{"title":"Accuracy of surrogate outcomes in predicting true endpoints of surgical periodontal therapy. A narrative review with a 20‐year longitudinal analysis","authors":"Muhammad H. A. Saleh, Abdusalam E. Alrmali, Fatemeh SamavatiJame, Hamzeh Almanshi, Shahad Alhazmi, Sawsan Abo‐Reyal, Hom‐Lay Wang, Ann Decker","doi":"10.1111/prd.70025","DOIUrl":"https://doi.org/10.1111/prd.70025","url":null,"abstract":"Background Periodontal clinical trials commonly use surrogate end points (e.g., probing pocket depth [PPD], clinical attachment level [CAL], bleeding on probing [BoP], and composite scores such as the Periodontal Risk Score [PRS]) for efficiency, yet tooth loss, treatment burden/cost, and re‐treatment are the definitive patient‐relevant measures of long‐term success. Methods This mixed‐methods study evaluated the predictive performance of three surrogate definitions and contextualized the findings with a 50‐year narrative review of longitudinal evidence linking PPD, CAL, and BoP to tooth retention. Additionally, a retrospective cohort (2001–2024) of 160 patients (919 teeth) treated at the University of Michigan was studied. Each participant had baseline PPD ≥6 mm after initial therapy (sites nonresponsive to initial nonsurgical therapy) and received up to 20 years of supportive periodontal therapy (SPT) following active periodontal therapy (APT). Three surrogate definitions: TEP A (no pockets ≥6 mm), TEP B (pockets ≤4 mm without BoP), and the PRS were compared against two true end points: tooth loss due to periodontitis (TLP) and need for additional therapy (re‐treatment). Logistic regression with generalized estimating equations was used to estimate sensitivity, specificity, positive/negative predictive values, and area under the curve (AUC). Results Overall, tooth loss was 28.4%, with 18.9% due to periodontitis. Additional treatment was required by 91.5% of patients. For TLP, TEP‐B provided the highest sensitivity, whereas PRS = 3 provided the highest specificity and positive predictive value (AUC = 0.556, <jats:italic>p</jats:italic> = 0.021). PRS ≥2 showed the best overall discrimination/accuracy for TLP (AUC = 0.637, <jats:italic>p</jats:italic> < 0.001). TEP‐A and TEP‐B demonstrated modest discrimination (AUC = 0.567, <jats:italic>p</jats:italic> < 0.007 and AUC = 0.549, <jats:italic>p</jats:italic> = 0.047, respectively). For re‐treatment, TEP‐B yielded 82.2% sensitivity, and PRS = 3 demonstrated 96.6% specificity (PPV = 96.8%); PRS ≥2 alone achieved AUC = 0.625 ( <jats:italic>p</jats:italic> = 0.033), while no significant differences were observed among the remaining models. Conclusions For practical application, baseline risk stratification can be performed using PRS ≥2 to support early screening for periodontitis‐related tooth loss, while PRS = 3 can be reserved for high‐confidence confirmation when minimizing false positives is critical. During postsurgical follow‐up after APT and throughout SPT, TEP‐B (PPD ≤4 mm with no BoP) can be used as the primary monitoring target to flag likely instability and identify teeth likely to require re‐treatment, whereas PRS = 3 can be applied to guide final treatment decisions or resource‐intensive interventions.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"31 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147507930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alberto Monje, Ronald E. Jung, Cristina Valles, Nadja Naenni
Background The objective of the present review is to explore the evidence and biological plausibility of factors that may expose dental implants to a greater likelihood of developing peri‐implantitis. Material and Methods An electronic screening on the PubMed library the was carried out to identify potential emerging factors that influence the onset/progression of peri‐implantitis. These factors were explored and are presented in a narrative review. Results Seven major emerging factors were pinpointed as emerging risk factors influencing the onset/progression of peri‐implantitis. Concerning (1) anatomy‐related risk factors, it seems that crestal soft tissue thickness and the dimension of the mucosal attachment are factors worth being assessed in order to understand the susceptibility of implants to peri‐implantitis. In turn, concerning (2) prosthesis‐related factors, certain implant‐abutment connections may be more prone to peri‐implantitis. Moreover, (3) surgery‐related factors, in particular as regards inadequate bucco‐lingual and mesio‐distal positioning, were seen to be contributors to peri‐implantitis, while apico‐coronal implant positioning might be dictated by the emergence profile and the crestal connective tissue height. Inconclusive findings were obtained concerning (4) the type and materials of implant‐supportive restorations. However, a lack of cleansability and the convexity of the emergence profile were suggested to be key elements in promoting inflammation. Implant‐supported fixed restorations, in contrast to implant‐retained overdentures, may increase the likelihood of developing peri‐implantitis in high‐risk individuals, since monitoring and plaque control are often jeopardized. Furthermore, (5) the regular intake of certain medication may increase the susceptibility to disease by interrupting regular homeostasis and tissue repair. In turn, (6) non‐controlled systemic disorders or a history of peri‐implantitis were seen to be strongly associated with peri‐implantitis. Lastly, (7) operator‐related factors, including the level of training in implant surgery and implant prosthodontics, were also regarded as risk factors for peri‐implantitis. Conclusions Emerging factors are yet to be validated by scientific data. However, aiming at preventing disease onset and progression, clinicians are encouraged to apply all measures known to affect hard and soft tissue breakdown and plaque accumulation in the pursuit of long‐term peri‐implant health. Moreover, patient‐related factors must be identified for proper patient selection in implant therapy. Education and training in implant surgery and implant prosthodontics are needed to prevent peri‐implantitis.
{"title":"Emerging risk factors influencing the occurrence of peri‐implantitis","authors":"Alberto Monje, Ronald E. Jung, Cristina Valles, Nadja Naenni","doi":"10.1111/prd.70031","DOIUrl":"https://doi.org/10.1111/prd.70031","url":null,"abstract":"Background The objective of the present review is to explore the evidence and biological plausibility of factors that may expose dental implants to a greater likelihood of developing peri‐implantitis. Material and Methods An electronic screening on the PubMed library the was carried out to identify potential emerging factors that influence the onset/progression of peri‐implantitis. These factors were explored and are presented in a narrative review. Results Seven major emerging factors were pinpointed as emerging risk factors influencing the onset/progression of peri‐implantitis. Concerning (1) anatomy‐related risk factors, it seems that crestal soft tissue thickness and the dimension of the mucosal attachment are factors worth being assessed in order to understand the susceptibility of implants to peri‐implantitis. In turn, concerning (2) prosthesis‐related factors, certain implant‐abutment connections may be more prone to peri‐implantitis. Moreover, (3) surgery‐related factors, in particular as regards inadequate bucco‐lingual and mesio‐distal positioning, were seen to be contributors to peri‐implantitis, while apico‐coronal implant positioning might be dictated by the emergence profile and the crestal connective tissue height. Inconclusive findings were obtained concerning (4) the type and materials of implant‐supportive restorations. However, a lack of cleansability and the convexity of the emergence profile were suggested to be key elements in promoting inflammation. Implant‐supported fixed restorations, in contrast to implant‐retained overdentures, may increase the likelihood of developing peri‐implantitis in high‐risk individuals, since monitoring and plaque control are often jeopardized. Furthermore, (5) the regular intake of certain medication may increase the susceptibility to disease by interrupting regular homeostasis and tissue repair. In turn, (6) non‐controlled systemic disorders or a history of peri‐implantitis were seen to be strongly associated with peri‐implantitis. Lastly, (7) operator‐related factors, including the level of training in implant surgery and implant prosthodontics, were also regarded as risk factors for peri‐implantitis. Conclusions Emerging factors are yet to be validated by scientific data. However, aiming at preventing disease onset and progression, clinicians are encouraged to apply all measures known to affect hard and soft tissue breakdown and plaque accumulation in the pursuit of long‐term peri‐implant health. Moreover, patient‐related factors must be identified for proper patient selection in implant therapy. Education and training in implant surgery and implant prosthodontics are needed to prevent peri‐implantitis.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"23 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147507920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jia-Hui Fu, Hui Jia Sophia Choo, Ding-Sen Ong, Henry Kwek
Horizontal bone augmentation is a fundamental surgical procedure in regenerative implant dentistry. In recent decades, this procedure has evolved, enabling clinicians to achieve predictable and stable horizontal bone augmentation that supports dental implant restorations. This narrative review summarizes the current literature on the biological mechanisms underlying bone regeneration and the key concepts of horizontal bone augmentation using various surgical techniques. A search of the electronic databases PubMed and Medline was conducted to gather scientific evidence regarding the surgical principles, biomaterials, soft tissue considerations, different methods of horizontal bone augmentation, the stability of regenerated bone, and the associated survival rates of implant restorations. The findings indicated that horizontal bone augmentation techniques could reliably increase bone width (ranging from 3 to 5 mm), over follow-up periods of 10 years or more. The long-term stability of this regenerated bone can be predictably attained by considering these four key parameters: (1) Careful case selection: A contained alveolar ridge defect in a non-smoking patient with optimal glycemic control and good oral hygiene. (2) Adherence to biologically sound surgical principles: This includes ensuring primary wound closure, maintaining adequate blood supply, creating and preserving space for augmentation and achieving overall stability of the surgical site during the healing phase. (3) Selection of appropriate biomaterials to facilitate effective bone regeneration. (4) Management of soft tissue through surgical interventions to create a stable wound during bone augmentation, as well as to maintain peri-implant bone health. This review presents clinical cases with long-term follow-up to illustrate the importance of these various aspects of bone augmentation in ensuring predictable long-term stability of regenerated bone.
{"title":"Long-term stability of horizontal bone augmentation at implant sites.","authors":"Jia-Hui Fu, Hui Jia Sophia Choo, Ding-Sen Ong, Henry Kwek","doi":"10.1111/prd.70026","DOIUrl":"https://doi.org/10.1111/prd.70026","url":null,"abstract":"<p><p>Horizontal bone augmentation is a fundamental surgical procedure in regenerative implant dentistry. In recent decades, this procedure has evolved, enabling clinicians to achieve predictable and stable horizontal bone augmentation that supports dental implant restorations. This narrative review summarizes the current literature on the biological mechanisms underlying bone regeneration and the key concepts of horizontal bone augmentation using various surgical techniques. A search of the electronic databases PubMed and Medline was conducted to gather scientific evidence regarding the surgical principles, biomaterials, soft tissue considerations, different methods of horizontal bone augmentation, the stability of regenerated bone, and the associated survival rates of implant restorations. The findings indicated that horizontal bone augmentation techniques could reliably increase bone width (ranging from 3 to 5 mm), over follow-up periods of 10 years or more. The long-term stability of this regenerated bone can be predictably attained by considering these four key parameters: (1) Careful case selection: A contained alveolar ridge defect in a non-smoking patient with optimal glycemic control and good oral hygiene. (2) Adherence to biologically sound surgical principles: This includes ensuring primary wound closure, maintaining adequate blood supply, creating and preserving space for augmentation and achieving overall stability of the surgical site during the healing phase. (3) Selection of appropriate biomaterials to facilitate effective bone regeneration. (4) Management of soft tissue through surgical interventions to create a stable wound during bone augmentation, as well as to maintain peri-implant bone health. This review presents clinical cases with long-term follow-up to illustrate the importance of these various aspects of bone augmentation in ensuring predictable long-term stability of regenerated bone.</p>","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146150115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yasir Nabeel Al‐Mohammad, Caroline Kelly, Petrana Martinekova, Alexander Schulze Wenning, Szilvia Kiss‐Dala, Noémi Gede, Beáta Kerémi, Zsolt Németh, Péter Hermann, László Márk Czumbel, Krisztina Mikulás, Péter Hegyi, Anton Sculean, Gábor Varga
Hundreds of millions of people have one or more missing teeth. Consequently, a substantial number of patients undergo implant therapy each year. However, technical complications and soft tissue inflammation associated with the implant abutment or the type of restoration can lead to bone loss and, ultimately, implant failure. Using the methodology of network meta‐analysis to rigorously compare and contrast the clinical performance of the three commonly used abutment materials: titanium (Ti), zirconium (Zr), and polyetheretherketone (PEEK) polymer. Until May 2025, a systematic search was performed in MEDLINE (PubMed), EMBASE, Scopus, and CENTRAL to find clinical studies comparing Ti, Zr, and PEEK implant abutments. Case reports, case series, in vitro, and in vivo studies were excluded. The Risk of Bias Tool 2, ROBINS‐I, and GRADE approaches were used for quality and certainty assessment. Thirty‐four articles (950 patients) were included, with various follow‐ups. All abutments had high survival rates and no significant differences in marginal bone loss (BL), probing depth (PD), bleeding on probing (BOP), and plaque index (PI). There was no significant difference between Zr and Ti for papillary index (PAP), with a general trend toward better results in Zr, which may be of clinical significance. There was a statistically significant difference in soft tissue discoloration (ΔE) values and technical complications of Zr versus Ti [MD: −2.03, CI: −3.89 to −0.18] and [OR: 0.26, CI: 0.09 to 0.72], respectively, indicating better esthetics and fewer technical complications in Zr. Both Ti and Zr are clinically successful and biologically acceptable. PEEK abutments demonstrated comparable characteristics with both Ti and Zr. However, more studies about PEEK and cost‐effectiveness analyses should also be performed to find the best options for clinical applications. PEEK can be a good alternative to Ti and Zr abutments for single‐tooth replacement in the anterior and premolar regions.
{"title":"Zirconia, titanium, and polyetheretherketone implant abutments show equal long‐term clinical success—A systematic review and network meta‐analysis","authors":"Yasir Nabeel Al‐Mohammad, Caroline Kelly, Petrana Martinekova, Alexander Schulze Wenning, Szilvia Kiss‐Dala, Noémi Gede, Beáta Kerémi, Zsolt Németh, Péter Hermann, László Márk Czumbel, Krisztina Mikulás, Péter Hegyi, Anton Sculean, Gábor Varga","doi":"10.1111/prd.70018","DOIUrl":"https://doi.org/10.1111/prd.70018","url":null,"abstract":"Hundreds of millions of people have one or more missing teeth. Consequently, a substantial number of patients undergo implant therapy each year. However, technical complications and soft tissue inflammation associated with the implant abutment or the type of restoration can lead to bone loss and, ultimately, implant failure. Using the methodology of network meta‐analysis to rigorously compare and contrast the clinical performance of the three commonly used abutment materials: titanium (Ti), zirconium (Zr), and polyetheretherketone (PEEK) polymer. Until May 2025, a systematic search was performed in MEDLINE (PubMed), EMBASE, Scopus, and CENTRAL to find clinical studies comparing Ti, Zr, and PEEK implant abutments. Case reports, case series, in vitro, and in vivo studies were excluded. The Risk of Bias Tool 2, ROBINS‐I, and GRADE approaches were used for quality and certainty assessment. Thirty‐four articles (950 patients) were included, with various follow‐ups. All abutments had high survival rates and no significant differences in marginal bone loss (BL), probing depth (PD), bleeding on probing (BOP), and plaque index (PI). There was no significant difference between Zr and Ti for papillary index (PAP), with a general trend toward better results in Zr, which may be of clinical significance. There was a statistically significant difference in soft tissue discoloration (ΔE) values and technical complications of Zr versus Ti [MD: −2.03, CI: −3.89 to −0.18] and [OR: 0.26, CI: 0.09 to 0.72], respectively, indicating better esthetics and fewer technical complications in Zr. Both Ti and Zr are clinically successful and biologically acceptable. PEEK abutments demonstrated comparable characteristics with both Ti and Zr. However, more studies about PEEK and cost‐effectiveness analyses should also be performed to find the best options for clinical applications. PEEK can be a good alternative to Ti and Zr abutments for single‐tooth replacement in the anterior and premolar regions.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"25 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145651141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of the paper was to present the potential for alveolar bone regeneration following the autotransplantation of immature teeth, based on a literature review and case presentations. Surgical treatment planning for successful healing is discussed with regard to donor selection, the stage of root development, the morphology and position of the donor tooth and the size of the apical foramen. The follow-up observations include pulp healing, the regeneration of Herwig's epithelial root sheath and periodontal healing. Differences between unerupted and erupted teeth, as well as the role of a dental follicle during the surgical removal of the donor tooth were discussed. Additionally, the changes associated with tooth eruption and the role of the periodontal ligament (PDL) in promoting bone formation after the autotransplantation of immature teeth were described. By utilizing the natural healing capacity of the PDL, autotransplantation represents a valuable treatment option for restoring dentition and promoting alveolar bone regeneration in patients with missing teeth or dental anomalies. Clinical and radiological documentation, along with the treatment descriptions of three young orthodontic patients illustrate the concepts discussed provide clinical guidelines for the autotransplantation of immature teeth.
{"title":"Alveolar bone regeneration after transplantation of immature teeth in orthodontic patients.","authors":"E Czochrowska,P Plakwicz","doi":"10.1111/prd.70023","DOIUrl":"https://doi.org/10.1111/prd.70023","url":null,"abstract":"The aim of the paper was to present the potential for alveolar bone regeneration following the autotransplantation of immature teeth, based on a literature review and case presentations. Surgical treatment planning for successful healing is discussed with regard to donor selection, the stage of root development, the morphology and position of the donor tooth and the size of the apical foramen. The follow-up observations include pulp healing, the regeneration of Herwig's epithelial root sheath and periodontal healing. Differences between unerupted and erupted teeth, as well as the role of a dental follicle during the surgical removal of the donor tooth were discussed. Additionally, the changes associated with tooth eruption and the role of the periodontal ligament (PDL) in promoting bone formation after the autotransplantation of immature teeth were described. By utilizing the natural healing capacity of the PDL, autotransplantation represents a valuable treatment option for restoring dentition and promoting alveolar bone regeneration in patients with missing teeth or dental anomalies. Clinical and radiological documentation, along with the treatment descriptions of three young orthodontic patients illustrate the concepts discussed provide clinical guidelines for the autotransplantation of immature teeth.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"368 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicola Alberto Valente,Salvatore D'Amato,Mauro Farella
After somatic growth ceases, craniofacial remodeling continues throughout adulthood, and teeth maintain a slow but persistent tendency to erupt. These ongoing skeletal and dental changes contribute to the progressive infraocclusion of dental implants. Our aim was to critically evaluate the evidence on late facial growth and continuous dentoalveolar eruption, and their implications for timing, risk assessment, and management of dental implants. A critical review of the current literature was conducted, focusing on longitudinal studies, clinical trials, and systematic reviews addressing residual facial bone remodeling, dentoalveolar eruption, and implant infraocclusion. Particular attention was given to patient-specific factors and patient-reported outcomes. Late craniofacial growth and continuous eruption of natural teeth contribute to spatial discrepancies between implants and adjacent dentition, even in skeletally mature adults. Younger age, increased anterior facial height, hyperdivergent facial patterns, and high smile lines were identified as key risk factors for implant infraocclusion. While delaying implant placement may reduce the risk of infraocclusion, there is no clear age threshold beyond which implants are entirely stable. Certain surgical techniques and prosthetic designs may mitigate long-term infraocclusion, and alternative treatments such as orthodontic space closure or adhesive bridges may provide a viable solution in selected cases. Progressive infraocclusion of implants is a multifactorial phenomenon influenced by residual craniofacial growth and alveolar changes. A thorough understanding of these biological processes and associated risk factors is essential to guide clinicians in selecting the optimal timing for implant placement and in considering alternative treatment strategies when appropriate. An evidence-based, patient-centered approach can help improve long-term functional and aesthetic outcomes, as well as patient satisfaction.
{"title":"Late facial growth and continuous dentoalveolar eruption: Implications for optimal dental implant placement.","authors":"Nicola Alberto Valente,Salvatore D'Amato,Mauro Farella","doi":"10.1111/prd.70024","DOIUrl":"https://doi.org/10.1111/prd.70024","url":null,"abstract":"After somatic growth ceases, craniofacial remodeling continues throughout adulthood, and teeth maintain a slow but persistent tendency to erupt. These ongoing skeletal and dental changes contribute to the progressive infraocclusion of dental implants. Our aim was to critically evaluate the evidence on late facial growth and continuous dentoalveolar eruption, and their implications for timing, risk assessment, and management of dental implants. A critical review of the current literature was conducted, focusing on longitudinal studies, clinical trials, and systematic reviews addressing residual facial bone remodeling, dentoalveolar eruption, and implant infraocclusion. Particular attention was given to patient-specific factors and patient-reported outcomes. Late craniofacial growth and continuous eruption of natural teeth contribute to spatial discrepancies between implants and adjacent dentition, even in skeletally mature adults. Younger age, increased anterior facial height, hyperdivergent facial patterns, and high smile lines were identified as key risk factors for implant infraocclusion. While delaying implant placement may reduce the risk of infraocclusion, there is no clear age threshold beyond which implants are entirely stable. Certain surgical techniques and prosthetic designs may mitigate long-term infraocclusion, and alternative treatments such as orthodontic space closure or adhesive bridges may provide a viable solution in selected cases. Progressive infraocclusion of implants is a multifactorial phenomenon influenced by residual craniofacial growth and alveolar changes. A thorough understanding of these biological processes and associated risk factors is essential to guide clinicians in selecting the optimal timing for implant placement and in considering alternative treatment strategies when appropriate. An evidence-based, patient-centered approach can help improve long-term functional and aesthetic outcomes, as well as patient satisfaction.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"245 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maud Joosstens, Cees Valkenburg, Fridus Van der Weijden
Maintaining optimal oral hygiene is important for overall oral care, ensuring the well‐being of teeth and their surrounding tissues. In addition, it promotes fresh breath and a pleasing smile. A key element of oral self‐care is the daily use of toothpaste during regular brushing. This plays an important role in preventing tooth decay and addressing broader oral health concerns like periodontal diseases. Toothpaste ingredients offer significant benefits to oral health, particularly stannous fluoride, which contributes to the efficacy of toothpaste formulations by demonstrating notable anticariogenic and antibacterial properties. However, toothpaste has potential side effects, such as those caused by flavoring, and sodium lauryl sulfate, a foaming agent known for its potential to irritate mucous membranes. Beyond toothpaste, the integration of mouthwash into daily oral care routines offers the potential to further improve overall oral hygiene. Chlorhexidine in mouthwash formulations stands out as an active ingredient that is highly effective. This paper investigates the effects of chemical plaque inhibitors where possible through comprehensive systematic evaluations of existing literature. It aimed to provide an understanding of how chemical agents used in oral self‐care contribute to promoting and maintaining optimal oral hygiene.
{"title":"Chemical agents to control biofilm formation in step 1 of care—Toothpastes and mouthwashes/concepts and challenges","authors":"Maud Joosstens, Cees Valkenburg, Fridus Van der Weijden","doi":"10.1111/prd.70022","DOIUrl":"https://doi.org/10.1111/prd.70022","url":null,"abstract":"Maintaining optimal oral hygiene is important for overall oral care, ensuring the well‐being of teeth and their surrounding tissues. In addition, it promotes fresh breath and a pleasing smile. A key element of oral self‐care is the daily use of toothpaste during regular brushing. This plays an important role in preventing tooth decay and addressing broader oral health concerns like periodontal diseases. Toothpaste ingredients offer significant benefits to oral health, particularly stannous fluoride, which contributes to the efficacy of toothpaste formulations by demonstrating notable anticariogenic and antibacterial properties. However, toothpaste has potential side effects, such as those caused by flavoring, and sodium lauryl sulfate, a foaming agent known for its potential to irritate mucous membranes. Beyond toothpaste, the integration of mouthwash into daily oral care routines offers the potential to further improve overall oral hygiene. Chlorhexidine in mouthwash formulations stands out as an active ingredient that is highly effective. This paper investigates the effects of chemical plaque inhibitors where possible through comprehensive systematic evaluations of existing literature. It aimed to provide an understanding of how chemical agents used in oral self‐care contribute to promoting and maintaining optimal oral hygiene.","PeriodicalId":19736,"journal":{"name":"Periodontology 2000","volume":"5 1","pages":""},"PeriodicalIF":18.6,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145583116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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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