Predictors for tooth loss in periodontitis patients: Systematic review and meta-analysis

Periodontal Probing Depth Trajectory in 10 Years of Follow-Up as Associated With Tooth Loss

AIM

To elucidate whether ranked probing depth (PD) data translate into ranked PD outcomes after 10 years of follow-up and the associated tooth loss.

MATERIALS AND METHODS

From the Study of Health in Pomerania (SHIP-START), all participants were retrospectively included with complete PD measurements in both baseline and 10-year follow-up, comprising 1887 participants. The trajectory of percentile-based quintiles of mean PD measurements was followed.

RESULTS

Quintiles of mean PD at baseline were, in a dose dependent manner, associated with the number of teeth at baseline, number of teeth after 10 years and involved risk of tooth loss. The trajectory of membership to individual PD quintiles indicated that the majority of participants remained in or near their baseline quintile after reaching the 10-year end analysis. Periodontal risk factors assessed at baseline continued to affect PD outcomes at follow-up. Two categories of tooth loss were identified: 1-2 teeth lost versus ≥ 3 teeth and differentiated by baseline PD.

CONCLUSION

PD severity ranked within this population translates, in a dose-dependent manner, to follow-up tooth loss even after many years. This underlines the prospective importance of pocket probing in the dental practice. Ranked PD offers a simple measure to identify patients at high risk of tooth loss.

Porphyromonas gingivalis Outer Membrane Vesicles Promote Gingival Fibroblasts Senescence via IL21R-AS1

AIMS

Periodontitis, a chronic inflammatory disease, is associated with accelerated cellular senescence. This study aims to explore how Porphyromonas gingivalis (P. gingivalis) outer membrane vesicles (OMVs) induce senescence and senescence-associated secretory phenotype (SASP) in human gingival fibroblasts (HGFs), focusing on the role of lncRNAs in promoting periodontitis progression.

METHODS

In vivo, gingival senescence was assessed via immunohistochemistry while bone loss was evaluated using micro-CT, HE and TRAP staining. In vitro, HGFs senescence was validated using CCK-8, SA-β-gal staining, western blot and immunofluorescence assays. IL21R-AS1 was transfected with targeted siRNAs and overexpression plasmids to verify its function. Dual-luciferase reporter assays and rescue experiments were conducted to elucidate the competing endogenous RNA (ceRNA) mechanism of IL21R-AS1. Upstream transcription factors of IL21R-AS1 were validated by CUT&Tag-qPCR and western blot.

RESULTS

P. gingivalis OMVs induced gingival tissue senescence and alveolar bone loss in vivo. In vitro, P. gingivalis OMVs promoted HGFs senescence and SASP via IL21R-AS1. IL21R-AS1 acted as a ceRNA by sponging miR-500a-3p, thereby enhancing the regulation of FBXW7. Moreover, P. gingivalis OMVs activated TLR4 and increased PAX5 expression, leading to elevated IL21R-AS1 levels.

CONCLUSIONS

P. gingivalis OMVs promote HGFs senescence SASP by the upregulation of IL21R-AS1, which acts as a ceRNA, mediating the miR-500a-3p/FBXW7 axis and contributes to the progression of periodontitis. These findings offer novel insights into the molecular mechanisms of OMVs-induced senescence and periodontitis.

Development of an artificial intelligence model for optimizing periodontal therapy decision-making: a retrospective longitudinal cohort study

OBJECTIVES

This study aims to develop and validate an artificial intelligence (AI) - driven model to assist periodontal therapy decision-making and minimize tooth loss.

METHODS

A retrospective longitudinal cohort study was conducted using clinical and radiographic data from 3,347 teeth treated and followed up for at least 10 years. The parameters included in the machine learning training and testing processes included: probing pocket depth (PPD), bone loss (BL), systemic diseases, therapy type, and others. Various machine learning models were developed and evaluated for accuracy, precision, recall, F1-score, and Area Under the Receiver Operating Characteristic Curve (AUC-ROC).

RESULTS

The Random Forest model demonstrated superior performance and was selected as the final predictive model achieving an AUC score of 0.91 and an accuracy of 0.93. Significant associations were found between tooth loss and variables such as age, PPD, bone loss, and furcation involvement.

CONCLUSION

This AI-driven platform may provide a reliable tool for stratifying periodontal therapy decisions and predicting tooth loss risk, offering clinicians a supportive approach to personalize treatment plans. However, the study's retrospective design and reliance on traditional clinical metrics highlight the need for future prospective studies.

CLINICAL SIGNIFICANCE

This study introduces and validates a novel AI-driven predictive model for periodontal therapy, utilizing data from treatment cases. Unlike previous models, this approach integrates multiple clinical and radiographic parameters, demonstrating high predictive accuracy (AUC=0.91, accuracy=0.93). The use of the Random Forest algorithm allows for robust predictions, offering an innovative, data-driven approach to periodontal treatment planning. Implementing AI in periodontal therapy decision-making may have the potential to improve patient outcomes by guiding clinicians toward optimal treatment strategies, enhancing therapeutic precision, and reducing the likelihood of unnecessary interventions.

Dimethyl fumarate modulates M1/M2 macrophage polarization to ameliorate periodontal destruction by increasing TUFM-mediated mitophagy

Periodontitis is a common oral disease characterized by progressive alveolar bone resorption and inflammation of the periodontal tissues. Dimethyl fumarate (DMF) has been used in the treatment of various immune-inflammatory diseases due to its excellent anti-inflammatory and antioxidant functions. Here, we investigated for the first time the therapeutic effect of DMF on periodontitis. In vivo studies showed that DMF significantly inhibited periodontal destruction, enhanced mitophagy, and decreased the M1/M2 macrophage ratio. In vitro studies showed that DMF inhibited macrophage polarization toward M1 macrophages and promoted polarization toward M2 macrophages, with improved mitochondrial function, inhibited oxidative stress, and increased mitophagy in RAW 264.7 cells. Furthermore, DMF increased intracellular mitochondrial Tu translation elongation factor (TUFM) levels to maintain mitochondrial homeostasis, promoted mitophagy, and modulated macrophage polarization, whereas TUFM knockdown decreased the protective effect of DMF. Finally, mechanistic studies showed that DMF increased intracellular TUFM levels by protecting TUFM from degradation via the ubiquitin-proteasomal degradation pathway. Our results demonstrate for the first time that DMF protects mitochondrial function and inhibits oxidative stress through TUFM-mediated mitophagy in macrophages, resulting in a shift in the balance of macrophage polarization, thereby attenuating periodontitis. Importantly, this study provides new insights into the prevention of periodontitis.

A systematic review of the patient reported outcome measures used to assess the impact of periodontitis and peri-implantitis on oral health related quality of life

INTRODUCTION

Periodontal disease (PD) and peri-implantitis (PI) can have a significant impact on oral health related quality of life. It is important that any patient reported outcome measures accurately reflect this impact.

AIMS

To identify the measures used to assess the impact of periodontal disease and peri-implantitis on oral health related quality of life. To assess the psychometric properties of the measures identified by applying an adapted version of the Consensus-based standards for the selection of health measurement instruments (COSMIN) checklist.

MATERIALS AND METHODS

A search of the literature incorporated relevant MeSH terms across four separate databases: Scopus, Web of Science, Medline and Embase. Following the removal of duplicates, studies meeting the inclusion criteria were screened. Any condition specific measure or a measure appearing greater than five times was analysed in accordance with the COSMIN criteria.

RESULTS

A total of 2103 articles were identified, of which 140 proceeded to full text review. A total of eight different OHRQoL measures were identified and psychometrically analysed.

DISCUSSION

The majority of measures used to assess the impact of PD and PI were not validated on local populations and were non-specific, generated by clinicians and researchers. The three condition specific measures were adaptations of the Oral Health Impact Profile, a non-specific patient reported outcome measure which may not accurately reflect the specific signs, symptoms and overall impact of PD/PI on an individual's OHRQoL.

CONCLUSION

There is a necessity for a condition-specific instrument to be developed to ensure that the impact of periodontal disease and peri-implantitis on OHRQoL is captured accurately.

Treating Periodontitis Strictly Non-Surgically-A Retrospective Long-Term Analysis of Tooth Loss During Supportive Periodontal Care

Background/Objectives: Retrospective analysis of long-term periodontal tooth loss (PTL) during supportive periodontal care (SPC) in patients with Stage III/IV periodontitis who received strictly non-surgical periodontal treatment. Methods: Fully documented medical documentation of SPC > 5 years was analyzed at T0 (baseline), T1 (after Steps 1/2), and during SPC (T2). PTL, periodontal pocket depth (PD), bleeding on probing (BOP), tooth mobility (TM), furcation involvement (FI), and frequency of SPC were recorded. Each parameter was tested for significance in a bivariate analysis, before a multilevel logistic regression analysis was performed to identify possible factors with an impact on PTL during SPC. Results: A total of 51 women/64 men (T1 mean age 55.4 ± 10.3 yrs) were surveilled after 9.0 ± 2.4 yrs; 2647 teeth were included. On average, patients attended 10.6 ± 3.8 SPC sessions between T1 and T2; 77 patients (67%) attended at least 1/year. At T1, 68 teeth were lost; 6.1% of the remaining teeth showed FI, and 13.8% showed TM. During SPC, the PTL range was 118 (1.03 ± 1.21/patient). TM, FI, mean PD, and Stage IV periodontitis proved to be statistically significantly associated with increased PTL. Conclusions: PTL was low in this cohort. Nevertheless, at T1, it may be beneficial to focus on stopping TM by splinting the mobile teeth and reducing the PD or treating FI appropriately, understanding that these precise applications of surgical procedures could positively affect long-term tooth retention.

Oral health in adolescents: periodontal inflammatory biomarkers during orthodontic clear aligner therapy

OBJECTIVES

This prospective study aimed to evaluate periodontal inflammation in adolescents undergoing orthodontic treatment with clear aligners (Invisalign® Teen, Align Technology, San Jose, CA, USA). Key objectives included assessing the presence of 11 periodontitis-associated marker bacteria, active matrix metalloproteinase-8 concentrations in sulcular fluid, and the influence of IL-1 polymorphism genotypes on periodontal health.

MATERIALS AND METHODS

Fifty adolescent patients (13.3 ± 1.8 years) with mixed and permanent dentition participated. Gingival crevicular fluid samples were analyzed at multiple time points: before, during, and one year after aligner treatment. Periodontal health was assessed using the Gingivitis Index and the Modified Quigley-Hein Index. Genotypic analysis of IL-1 polymorphism was also performed. Statistical analyses included mixed linear models and generalized linear models to explore correlations.

RESULTS

All combinations of IL-1 polymorphism genotypes were found in the sample. No significant increase in periodontal inflammation or aMMP-8 concentrations was observed over the treatment period. Marker bacteria from the red and orange-associated complexes remained at low levels, while significant changes occurred in the orange and green complexes, particularly Capnocytophaga spp. (p = 0.0042) and Fusobacterium spp. (p = 0.0365). GI correlated significantly with aMMP-8 levels (p = 0.0017), but no genotype effect on GI was observed. MQH showed associations with pathogens from the orange and green complexes, including Capnocytophaga spp. and Fusobacterium spp.

CONCLUSIONS

Clear aligner treatment in adolescents, including those with an unfavorable genotype, does not increase periodontal inflammation when accompanied by good oral hygiene.

CLINICAL RELEVANCE

Regular periodontal monitoring and hygiene reinforcement is important during orthodontic treatment, especially in adolescent patients.

WDR36 inhibits the osteogenic differentiation and migration of periodontal ligament stem cells

BACKGROUND

Periodontitis is an inflammatory disease caused by the host's immune response and various interactions between pathogens, which lead to the loss of connective tissue and bone. In recent years, mesenchymal stem cell (SC) transplantation technology has become a research hotspot, which can form periodontal ligament, cementum, and alveolar bone through proliferation and differentiation.

AIM

To elucidate the regulatory effects of WD repeat-containing protein 36 (WDR36) on the senescence, migration, and osteogenic differentiation of periodontal ligament SCs (PDLSCs).

METHODS

The migration and chemotaxis of PDLSCs were detected by the scratch-wound migration test and transwell chemotaxis test. Alkaline phosphatase (ALP) activity, Alizarin red staining, calcium content, and real-time reverse transcription polymerase chain reaction (RT-qPCR) of key transcription factors were used to detect the osteogenic differentiation function of PDLSCs. Cell senescence was determined by senescence-associated β-galactosidase staining.

RESULTS

The 24-hour and 48-hour scratch-wound migration test and 48-hour transwell chemotaxis test showed that overexpression of WDR36 inhibited the migration/chemotaxis of PDLSCs. Simultaneously, WDR36 depletion promoted the migration/chemotaxis of PDLSCs. The results of ALP activity, Alizarin red staining, calcium content, and RT-qPCR showed that overexpression of WDR36 inhibited the osteogenic differentiation of PDLSCs, and WDR36 depletion promoted the osteogenic differentiation of PDLSCs. Senescence-associated β-galactosidase staining showed that 0.1 μg/mL icariin (ICA) and overexpression of WDR36 inhibited the senescence of PDLSCs, and WDR36 depletion promoted the osteogenic differentiation of PDLSCs.

CONCLUSION

WDR36 inhibits the migration and chemotaxis, osteogenic differentiation, and senescence of PDLSCs; 0.1 μg/mL ICA inhibits the senescence of PDLSCs. Therefore, WDR36 might serve as a target for periodontal tissue regeneration and the treatment of periodontitis.

Prevalence of Epstein-Barr Virus, Cytomegalovirus, and Periodontopathic Bacteria in Patients With Periodontitis: A Case-Control Study

OBJECTIVES

Opportunistic viruses such as cytomegalovirus (CMV) and Epstein-Barr virus (EBV) have been detected in gingival crevicular fluid (GCF) and saliva of patients with periodontal disease. However, the relationship between herpesviruses and periodontitis remains obscure. The aim of this case-control study was the detection and association of CMV and EBV with periodontitis.

MATERIAL AND METHODS

Forty-eight adults were included in this study: 24 patients with periodontitis (CP) and 24 periodontally healthy individuals (HS). All patients underwent periodontal examination, including probing depth (PD), clinical attachment loss (CAL), plaque index (PI), and bleeding on probing (BOP). Subgingival biofilm samples were collected from all patients and real-time PCR was performed for viral and bacterial detection. The odds ratio (OR) was calculated, and the chi-squared test or Fisher's exact test was performed to analyze the significant differences.

RESULTS

EBV was detected only in one healthy patient meanwhile no CMV was found. No statistically significant differences were found between the periodontal clinical parameters of EBV-positive patients and the negative ones: PI (p = 0.090), PD (p = 0.857), CAL (p = 0.801), and BOP (p = 0.104). Except for Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), Prevotella intermedia (Pi), and Treponema denticola (Td) showed a statistically significant association (p < 0.001) with the clinical periodontal parameters. Aa presence was not statistically associated with periodontal sites (p < 0.296). Tf and Pg were the most frequently detected periodontopathic bacteria in the CP group (91.7% sites).

CONCLUSION

The present case-control study showed that the prevalence of EBV and CMV did not show significant differences between the groups evaluated in the Spanish population.

PIK3R3 regulates differentiation and senescence of periodontal ligament stem cells and mitigates age-related alveolar bone loss by modulating FOXO1 expression

INTRODUCTION

Periodontal diseases are prevalent among middle-aged and elderly individuals. There's still no satisfactory solution for tooth loss caused by periodontal diseases. Human periodontal ligament stem cells (hPDLSCs) is a distinctive subgroup of mesenchymal stem cells, which play a crucial role in periodontal supportive tissues, but their application value hasn't been fully explored yet. As a regulatory subunit of PI3K, PIK3R3's role in stem cell regulation remains poorly comprehended.

OBJECTIVES

This study aims to explore the regulatory effect of PIK3R3 on differentiation and senescence of hPDLSCs and the underlying mechanism, as well as whether overexpression of PIK3R3 mitigate alveolar bone loss in aged rats.

METHODS

Human PDLSC lines with both PIK3R3 knockdown and overexpression are established. Osteogenic, adipogenic, chondrogenic and senescent induction are used to test the effect of PIK3R3 on senescence in vitro. Model of alveolar bone loss in aged mice is used to reveal the effect of PIK3R3 in vivo. FOXO1 siRNA is used for mechanism exploration.

RESULTS

Knockdown of PIK3R3 inhibits the mRNA and protein expression of markers in osteogenic, adipogenic, and chondrogenic differentiation of hPDLSCs but promotes in vitro senescence of hPDLSCs, including senescence markers expression, telomerase density and reactive oxygen species. Overexpression of PIK3R3 has the opposite effect. Furthermore, the result of Micro-CT and tissue section shows that overexpression of PIK3R3 in elder rats mitigates alveolar bone loss. Mechanistically, PIK3R3 regulates senescence of hPDLSCs through modulating FOXO1 expression. Expression of FOXO1 is altered when PIK3R3 is knocked down or overexpressed in senescent medium. Knockdown of FOXO1 promotes senescence of hPDLSCs and the senescence promoting effect of knocking down PIK3R3 is weakened when FOXO1 is highly expressed.

CONCLUSION

These findings indicate that PIK3R3 modulates senescence of hPDLSCs by regulating FOXO1 expression and shows promise as a therapeutic target for mitigating age-related alveolar bone loss.

Effect of Discontinuation of Supportive Periodontal Therapy on Periodontal Status-A Retrospective Study

AIM

To assess the impact of active (APT) and supportive periodontal therapy (SPT) on the change in probing depth (PD) and annual tooth loss in partially and fully compliant and drop-out patients.

MATERIAL AND METHODS

Data of 280 periodontally treated partially and fully compliant (regular supportive visits, SPT duration 5.5 ± 4.5 years) and 55 drop-out patients (SPT and drop-out duration 8.3 ± 3.8 years, only drop-out duration 5.3 ± 3.7 years) were recorded. PD data and the number of teeth present at the start of APT (T1) and at the start of SPT (T2) were taken from the patient files and evaluated at the time of the final examination (T3).

RESULTS

Annual tooth loss during SPT was significantly higher (p < 0.001) in drop-out patients than in partially and fully compliant patients (0.31 ± 0.50 vs. 0.19 ± 0.55, respectively). In partially and fully compliant and drop-out patients, the mean PD (all available site data) decreased significantly between T1 (3.61 ± 0.82 vs. 3.70 ± 0.73 mm) and T2 (2.68 ± 0.40 vs. 2.76 ± 0.42 mm), while the values increased again slightly up to T3 (2.74 ± 0.41 vs. 2.99 ± 0.75 mm).

CONCLUSIONS

In partially and fully compliant patients, SPT had a positive impact on PD stability and medium-term tooth preservation. In contrary to expectations, drop-out patients, PD did not return to baseline values, although PD stability was not achieved.

Association Between Physical Function and Edentulism in Older Adults: Findings from the Indonesian Family Life Survey 2014

This study aimed to determine the association between physical function and edentulism among older adults. The fifth wave of Indonesian Family Life Survey (IFLS-5) data was used. Physical function was evaluated through physical performance, physical capability, and appendicular skeletal muscle mass (ASM). Edentulous was found in 10.96% of 2554 older adults. Low physical performance (OR 2.02, 95% CI 1.32-3.09; P = .001) was shown to be associated with edentulism in the 60 to 69 age group. In the 70 to 79 age group, both low physical performance (OR 1.62, 95% CI 1.04-2.53; P = .033) and 1 dependency in ADL/IADL (OR 1.75, 95% CI 1.02-2.98; P = .04) were significantly associated with edentulism. Two or more dependencies in ADL/IADL (OR 4.02, 95% CI 1.15-13.99; P = .029) demonstrated significant association with edentulism in older adults ≥80 years. These findings highlighted the importance of maintaining natural teeth and improving oral health during the aging process.

Influence of mobility on the long-term risk of tooth extraction/loss in periodontitis patients. A systematic review and meta-analysis

The aim of this systematic review (SR) was to assess whether tooth mobility (TM) increases the risk of tooth extraction/loss. The protocol was registered in PROSPERO database (CRD42023485425). The focused PECO questions were as follows: (1) "In patients with periodontitis, undergoing periodontal treatment, are teeth affected by mobility at higher risk of being extracted/lost compared to non-mobile teeth, with a minimum follow-up of 10 years?" and (2) "In these patients, does varying degrees of tooth mobility increase the risk of tooth extraction/loss, with a minimum follow-up of 10 years?". Results were reported according to PRISMA statement. Electronic and manual searches were conducted to identify longitudinal studies. The different assessments of tooth mobility were pooled into three groups: TM0: Undetectable tooth mobility, TM1: Horizontal/Mesio-distal mobility ≤1 mm, TM2: Horizontal/Mesio-distal mobility >1 mm or vertical tooth mobility. Tooth loss was the primary outcome. Various meta-analyses were conducted, including subgroup analyses considering different follow-up lengths and the timing of TM assessment, along with sensitivity analyses. A trial sequential analysis was also performed. Eleven studies were included (1883 patients). The mean follow-up range was 10-25 years. The weighted total of included teeth, based on the sample size, was 18 918, with a total of 1604 (8.47%) extracted/lost teeth. The overall rate of tooth extraction/loss increased with increasing mobility: TM0 was associated with a 5.85% rate (866/14822), TM1 with the 11.8% (384/3255), TM2 with the 40.3% (339/841). Mobile teeth (TM1/TM2) were at an increased risk for tooth extraction/loss, compared to TM0 (HR: 2.85; [95% CI 1.88-4.32]; p < .00001). TM1 had a higher risk than TM0 (HR: 1.96; [95% CI 1.09-3.53]; p < .00001). TM2 had a higher risk than TM1 (HR: 2.85; [95% CI 2.19-3.70]; p < .00001) and TM0 (HR: 7.12; [95% CI 3.27-15.51]; p < .00001). The results of the tests for subgroup differences were not significant. Sensitivity meta-analyses yielded consistent results with other meta-analyses. Within the limits of the quality of the studies included in the meta-analyses, mobile teeth were at higher risk of being extracted/lost in the long-term and higher degrees of TM significantly influenced clinicians' decision to extract a tooth. However, most teeth can be retained in the long-term and thus TM should not be considered a reason for extraction or a risk factor for tooth loss, regardless of the degree of TM.

Correlation of serum vitamin D and IL-8 to stages of periodontitis: a case-control analysis

OBJECTIVES

The current literature lacks the correlation between serum levels of vitamin D and interleukin-8 (IL-8) to the stages of periodontitis. The present research objectives are to evaluate the serum levels of vitamin D and IL-8 in periodontitis participants and healthy controls and to measure their correlation with the stages of periodontitis.

METHODS

The current case-control study was conducted on patients with periodontitis and healthy controls. After obtaining a questionnaire from the participants, the following clinical parameters were measured; periodontal probing depth (PPD), clinical attachment loss (CAL), plaque index (PI), gingival index (GI), bleeding on probing (BOP), and tooth count. The serum levels of vitamin D and IL-8 were measured using ELISA kits. Then, we measured the correlation of the stages of periodontitis with the serum levels of vitamin D and IL-8.

RESULTS

Ninety-eight participants; 52 with periodontitis and 46 healthy controls were included. The patients with periodontitis showed a significantly lower level of vitamin D, higher PPD, CAL, BOP, and lower number of teeth than the controls. In addition, serum vitamin D significantly correlated with the stages of periodontitis. Serum IL-8 showed no significant difference between the study and control groups while it does not significantly correlate with the stages of periodontitis.

CONCLUSION

The current study's findings suggest a potential association between serum level of vitamin D with severity of periodontitis which necessitates screening vitamin D status in patients with periodontitis and investigating the possibility of vitamin D supplementation in decreasing the progression of periodontitis.

Tooth loss during long-term periodontal therapy in specialized practices - a retrospective cohort study from a periodontal practice-based research network (Perio-PBRN)

OBJECTIVES

To investigate tooth-specific, clinical tooth-, and patient-related factors associated with tooth loss (TL) in patients with mild to severe periodontitis treated in a periodontal practice-based research network (Perio-PBRN) over at least 5 years.

MATERIALS AND METHODS

The Perio-PBRN consists of five German periodontal practices where clinical data were collected regarding patient age, tooth type, bleeding on probing (BOP), pocket probing depth (PPD), furcation involvement (FI), number of attended appointments, and other variables of interest. The data were evaluated regarding factors influencing TL.

RESULTS

Data from 687 patients (aged 54.5 ± 11.1 years) with mild (N = 23, 3.35%), moderate (N = 247, 35.95%) or severe (N = 417, 60.70%) periodontitis and 15,931 teeth over a mean observation period of 6.83 ± 1.40 years per patient were gathered via the Perio-PBRN. In this period, a total of 657 teeth were lost (4.12%, overall TL: 0.14 ± 0.22 teeth/patient/y). The risk of TL was significantly increased for teeth with persistent PPD ≥ 6 mm (hazard ratio: 6.81 [95% confidence interval: 5.07-9.15] in comparison to PPD < 4 mm. Additionally, BOP (3.90 [2.46-6.19]), furcation involvement, jaw, age and tooth type showed a significant influence on TL, while number of visits were not significantly associated with TL.

CONCLUSIONS

Periodontal care of patients with moderate to severe disease in specialized practices was associated with a low rate of TL. Known tooth-related prognostic factors were confirmed. However, the results must be interpreted cautiously without knowledge of risk factors such as smoking and diabetes.

CLINICAL RELEVANCE

PBRNs can help gather large amounts of periodontal practice-level data.

TRIAL REGISTRATION

The study was registered in the German Clinical Trials Register (DRKS 00011448).

Systemic Factors Affecting Prognosis in Periodontics: Part II

This study gives an insight into certain systemic conditions and factors such as nutrition, age, hematological disorders, hypertension, smoking, obesity, and metabolic syndrome that have a notable effect on the periodontium. The review highlights the importance of taking these factors into consideration in periodontal therapy and their impact on the prognosis of periodontal therapies. The other systemic factors are discussed in detail elsewhere in the special issue.

Tooth loss from the perspective of studies employing a life course approach: a systematic review

The life course approach scrutinizes factors that shape the development of diseases over time. Tooth loss, which is influenced by social, behavioral and biological factors, can occur at various stages of life and tends to become more prevalent in later years. This systematic review examined the influence of socioeconomic, psychosocial, biological and behavioral adversities in life on the likelihood of tooth loss. Searches were conducted in the Embase, PubMed, Web of Science, Ovid, PsycINFO, Scopus and LILACS databases. Reference management was performed using EndNote online. The risk of bias was appraised using the Newcastle-Ottawa Scale (NOS). The electronic searches yielded 1366 records, 17 of which (13 cohort and four cross-sectional studies) met the inclusion criteria. According to the NOS, all studies had a low risk of bias. Two studies found a link between a lower education and higher incidence of tooth loss and socioeconomic status exerted a significant influence in 47% of the studies. Disadvantaged socioeconomic trajectories and health-related factors, such as smoking, general health perception and oral health behaviors, increased the likelihood of tooth loss. Factors such as dental visits, a history of toothache and exposure to fluoridated water influenced the likelihood of tooth loss. Individuals who experienced adversities in socioeconomic, behavioral and biological aspects throughout their life course were more prone to tooth loss.

Associations of tooth loss with risk of all-cause and cause-specific mortality among US adults with diabetes mellitus

OBJECTIVES

To determine whether tooth loss affects all-cause and cause-specific mortality in a nationally representative sample of adults with diabetes mellitus (DM) in the United States.

METHODS

This prospective cohort study involved 8207 participants aged 30 years or older at baseline, all diagnosed with diabetes mellitus and enrolled in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. Tooth loss was stratified into 28 teeth (complete), 20-27 teeth (tooth loss), 9-19 teeth (lacking functional), 1-8 teeth (severe tooth loss) and edentulism. To estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for all-cause and specific-cause mortality in diabetes mellitus participants according to tooth loss, multivariate cox proportional hazards regression models were used. Relationships between mortality and quartiles of mean tooth loss levels were analyzed, with the lowest quartile as the baseline for comparisons.

RESULTS

During a median of 6.92 years of follow-up, 2317 deaths were documented. After multivariate adjustments, higher tooth loss levels were significantly and non-linearly associated with higher risks of all-cause, CVD-related and DM-related mortality among participants with DM. When compared with the reference group of mean tooth loss levels, the highest quartile showed significantly increased risks: all-cause mortality (HR, 2.11; 95 % CI, 1.53-2.91, P-trend < 0.001), CVD-related mortality (HR, 3.24, 95 % CI, 1.54-6.85, P-trend < 0.001) and DM-related mortality (HR, 2.78, 95 % CI, 1.15-6.68, P-trend < 0.001).

CONCLUSIONS

Tooth loss is associated with an increased risk of all-cause, CVD-related and diabetes mellitus mortality among adults with diabetes mellitus in the US.

CLINICAL SIGNIFICANCE

This study presents evidence for physicians and dentists that higher tooth loss was significantly associated with increased risk of all-cause, CVD-related and diabetes mellitus mortality in a dose-response manner among adults with diabetes mellitus. Therefore, assessment of survival in individuals with diabetes mellitus could pay attention to the tooth loss.

Is There a Relationship Between the Dietary Inflammatory Index and Clinical Attachment Loss in Patients with Periodontitis?

OBJECTIVE

The pathogenesis of periodontal diseases is partially driven by oxidative stress. However, studies on the relationship between periodontitis and the inflammatory load of diet are still insufficient. Therefore, this study aimed to examine the relationship between the diet's inflammatory load and periodontitis and clinical attachment loss (CAL).

METHODS

This cross-sectional study included 119 participants diagnosed with periodontitis according to the 1999 classification. The dietary inflammatory index (DII) was calculated using three-day food consumption records and divided into quartiles (Q1, Q2, and Q3). Body mass index (BMI) was calculated as weight and height (kg/m2). Clinical attachment loss (CAL) score was determined, and the patients were grouped with those CAL scores as 7 < CAL and ≥7 CAL.

RESULTS

Of the 119 patients with periodontitis, aged 46.24 ± 12.84 years, 45.3% were found to have an anti-inflammatory diet profile (n = 54). When the daily energy and nutrient intake of individuals were examined, it was found that the intake of omega-3 fatty acids (p = 0.004), black tea (p = 0.021), and green pepper (p = 0.029) was higher in those with CAL < 7 compared to those with CAL ≥ 7. There was no relationship between the patients' DII and CAL values. Daily energy, protein, fiber, vitamin A, vitamin E, folic acid, Fe, Zn, and Mg intake in patients with an anti-inflammatory diet in Q1 were higher than in Q2 and Q3 (p < 0.001).

CONCLUSION

This study found no relationship between DII levels and CAL scores. However, it was observed that periodontitis patients following an anti-inflammatory diet had higher intakes of omega-3 fatty acids, vitamins A, E, and C, as well as zinc and magnesium which are nutrients known to be effective against inflammation. These patients also had CAL scores below 7. Therefore, reducing the inflammatory load of the diet may prevent the development of periodontitis, and further research in this regard would be beneficial.

Residual vertical defects: risk of disease progression, retreatment rates, and cost: a retrospective analysis

OBJECTIVES

This study aimed to explore the relationship between Radiographic Residual Vertical Defects (RVDs) and the progression of periodontitis in patients undergoing periodontal maintenance therapy (PMT).

MATERIALS AND METHODS

Teeth with RVDs were compared to the same contralateral teeth in the same patient. The study investigated the effect of smoking, diabetes, compliance, disease Stage, and Grade, baseline probing depth (PD), periodontal risk score (PRS), baseline pocket closure (PC) (≤ 4 mm), and tooth mobility on disease progression. We calculated the need for retreatment during PMT and its associated cost. Generalized estimation equations and linear and multilevel logistic regression analyses were employed for data analysis.

RESULTS

Each group had 139 teeth, accounting for 80 patients. Although the group with RVDs had similar PD reduction compared to the control teeth, the prevalence of PC at the last follow-up was reduced to half in the RVDs group (odds ratio OR = 0.5; p-value = 0.028), regardless of PC status at the baseline. RVDs were also significant predictors of tooth loss due to periodontitis (TLP), with an OR of 2.28 (p = 0.043). Patients with diabetes, Stage IV, higher mobility, and higher PRS scores had a higher risk of tooth loss due to periodontitis (OR = 4.71, 3.84, 3.64, and 5.97, respectively (P < 0.01). Incidences of sites requiring retreatment were similar in both groups, but the cost of treatment was 30% higher for teeth with RVDs. Grade C had the most significant influence on receiving retreatments (OR = 18.8, p = 0.005).

CONCLUSION

Teeth with RVDs represent a risk indicator for tooth loss compared to identical contralateral teeth with similar PD in the same patient. Teeth with RVD had more risk of pocket opening during follow-up.

CLINICAL RELEVANCE

While teeth with RVDs can be maintained long-term, they have twice the risk of pocket opening and tooth loss due to periodontitis during follow-up. Patients with systemic and local risk factors need to be monitored closely as they are at the highest risk of losing teeth with RVDs. The increased cost of retreatment for teeth with RVDs also has implications in terms of retention versus extraction and replacement.

Long-term assessment of the periodontal health of removable partial denture wearers: A systematic review and meta-analysis

STATEMENT OF PROBLEM

The long-term effects of wearing removable partial dentures (RPDs) remain unclear.

PURPOSE

This systematic review addressed the question "Is the long-term use of RPDs deleterious to the remaining teeth?"

MATERIAL AND METHODS

This review was guided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist. Six databases and nonpeer-reviewed literature were searched in April 2024 without language or follow-up restrictions. Only clinical studies evaluating RPD long-term use were included. The risk of bias and evidence certainty were assessed (RoB 2.0; ROBINS-I; GRADE), and meta-analyses were conducted for survival rate and periodontal health (α=.05).

RESULTS

A total of 5577 records were identified, and 46 studies covering data from 4359 prostheses and 4072 participants (mean age 60 ±5.2 years) were included. A low to moderate risk of bias was found. A 5-year survival rate of 95.1% (ER=0.951; 95% CI=0.900 to 0.977; P<.001) and 91.7% (ER=0.917; 95% CI=0.870 to 0.948; P<.001) was found for cast-clasp RPD and RPDs retained by telescopic crowns respectively, with no difference between them (P=.71). Abutments (OR=1.99, 95% CI=1.32 to 3.01; P=.001) and nonvital teeth (HR=2.961; 95% CI=2.023 to 4.335; P<.001) presented a higher risk of extraction after 5 years. Tooth mobility (P=.98) and probing depth (P=.50) remained unchanged, while the gingival index increased (MD=0.477 (95% CI=0.12 to 0.83; P=.008).

CONCLUSIONS

A high survival rate was found for both cast-clasp RPD and RPDs retained by telescopic crowns, with few periodontal changes to the remaining teeth.

Knowledge, attitudes, and practice related to tooth loss and dentures among patients with dental arch deficiencies

BACKGROUND

Tooth loss is a common problem that affects many people worldwide. Exploring knowledge, attitude, and practice (KAP) among patients can identify barriers and challenges in following recommended practices, providing valuable insights for dental healthcare providers, policymakers, and researchers. This study aimed to explore the KAP of patients with dental arch deficiencies regarding tooth loss and dentures.

METHODS

This web-based, cross-sectional study was conducted among patients with dental arch deficiencies using a self-designed questionnaire.

RESULT

3166 valid questionnaires were included. Participants' mean KAP scores were 6.84 ± 2.27 (possible range: 0 ~ 12), 39.4 ± 3.72 (possible range: 9 ~ 45), and 27.7 ± 4.36 (possible range: 8 ~ 40), respectively. Multivariable logistic regression analysis showed that knowledge (OR = 1.383), employed (OR = 1.805), family history (OR = 2.158), and treatment (OR = 1.683) were independently associated with attitude. Moreover, knowledge (OR = 1.239), attitude (OR = 1.250), female (OR = 0.619), age (OR = 0.967), college/bachelor (OR = 0.373), and master and above degree (OR = 0.418), employed (OR = 0.554) or student (OR = 0.434), with 10,001-20,000 Yuan household income per month (OR = 0.492), have been married (OR = 0.609), smoking (OR = 0.595), drinking (OR = 0.397), disease duration (OR = 0.972), with family history (OR = 1.676), and with treatment (OR = 3.492) were independently associated with practice (all P < 0.05).

CONCLUSION

Patients with dental arch deficiencies have insufficient knowledge, positive attitudes, and moderate practice toward tooth loss and dentures, which might be affected by multiple demographic factors.

Diagnostic accuracy of severe periodontitis for Ramfjord teeth based on different classifications

OBJECTIVE

To evaluate the accuracy of Ramfjord teeth (RT) protocol for the diagnosis of severe periodontitis based on different classifications and explore the misclassification bias such as teeth loss.

METHODS

Patients (n = 435) receiving full-mouth periodontal examination (FMPE) were included. Patients were classified as severe (stage III/IV) periodontitis and no/mild/moderate (no/stage I/II) periodontitis according to the case definition proposed by the Centers for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP)-(CDC/AAP), a new classification introduced by AAP and the European Federation of Periodontology (EFP)-(AAP/EFP), and consensus of Chinese experts (CCE). Sensitivity, specificity, positive predictive value, negative predictive value, Youden's index, and area under the receiver operating characteristic curve (AUROC) compared with FMPE were evaluated.

RESULTS

The specificity of RT was 86.8%, 92.2%, and 77.1% when compared with FMPE protocol based on CDC/AAP, AAP/EFP, and CCE classifications, while the AUROC value was 0.934, 0.961, and 0.886 specifically. The loss of the first molar leads to the greatest reduction in the detection rate of severe periodontitis.

CONCLUSIONS

RT showed the highest specificity based on the new AAP/EFP classification. The loss of the first molar leads to the greatest reduction in the detection rate of severe periodontitis.

Factors associated with furcation involvement and fixed prostheses: A cross-sectional study

OBJECTIVE

The study aims to explore the relationship between horizontal and vertical furcation involvement (FI) in teeth with or without a single unit fixed prosthesis (FP).

MATERIALS AND METHODS

Adult subjects presenting to the periodontics department requiring cone beam computed tomography (CBCT) analysis were recruited for this study. 79 patients, with a total of 200 teeth, were split into two groups based on the presence or absence of FP within the same patient. Our analysis considered patient-level factors like smoking, diabetes, and periodontal severity and tooth-level factors including root trunk length (RTL), probing depth (PD), periodontal supracrestal tissue height (STH), supracrestal tissue attachment (STH-PD), interproximal bone distance (IPBD) to the cementoenamel junction (CEJ) (control) or crown margin (Test), and the distance from the furcation to the CEJ (control) or crown margin (Test). Subsequently, we developed a predictive model for FI.

RESULTS

The presence of a prosthesis had a significant association with FI, with an odds ratio (OR) of 12.8 (p < 0.001). Other factors significantly correlated with FI were periodontitis (OR = 10.9; p = 0.006), buccal furcation site (OR = 5.70; p < 0.001), and PD (OR = 1.90; p = 0.027). FP placement increased IPBD by 1.08 mm (p < 0.001). The predictive model built for FI demonstrated a sensitivity of 92.9% and a specificity of 66.7%.

CONCLUSIONS

Fixed prosthesis significantly influenced FI only in periodontitis patients. Factors such as periodontitis Stage, probing depth, and buccal site contribute to FI. The high sensitivity of the predictive model highlights the importance of considering these correlations during treatment planning.

CLINICAL RELEVANCE

Comprehending FI factors is vital for devising customised treatment plans to halt disease progression and enhance outcomes of periodontal regenerative therapies.

Periodontal pockets: Predictors for site-related worsening after non-surgical therapy-A long-term retrospective cohort study

AIM

To evaluate site-related changes in periodontal pocket depth (PPD) after non-surgical periodontal therapy and to identify predictors for PPD changes in a retrospective patient data analysis.

MATERIALS AND METHODS

PPD, clinical attachment level, bleeding on probing, tooth mobility (TM), furcation involvement (FI), abutment status, adherence to supportive periodontal care (SPC) and SPC follow-ups were obtained from fully documented patient data before periodontal therapy (baseline, T0), after active periodontal therapy (APT, T1) and during SPC (T2). PPD changes were classified into deteriorated or unchanged/improved at the site level. Multi-level logistic regression analysis was performed to identify factors influencing PPD changes during SPC.

RESULTS

This retrospective study included 51 females and 65 males (mean T0 age: 54.8 ± 10.1 years, 25 smokers, 12 diabetics) suffering from Stage III/IV periodontitis. Evaluation outcome: T0/16,044 sampling sites/2674 teeth; T1/15,636/2606; T2/14,754/2459. During 9.0 ± 2.3 years SPC, PPD decreased (-1.33 ± 0.70 mm) by 21.8% of the sites, remained unchanged by 41.4% and increased (1.40 ± 0.78 mm) by 36.8%. Distopalatal FI (p < .001, odds ratio [OR]: 0.252, 95% confidence interval [CI] for OR: 0.118-0.540), residual pockets (p < .001, OR: 0.503, 95% CI: 0.429-0.590) and TM Degrees I-III (Degree I: p = .002, OR: 0.765, 95% CI: 0.646-0.905; Degree II: p = .006, OR: 0.658, 95% CI: 0.489-0.886; Degree III: p = .023, OR: 0.398, 95% CI: 0.180-0.879) correlated significantly with increasing PPD.

CONCLUSIONS

Over 75% of PPD remained unchanged or increased during SPC. Distopalatal FI, TM Degrees I-III and residual pockets after APT lead to worsening of periodontal pockets.

Artificial intelligence and personalized diagnostics in periodontology: A narrative review

Periodontal diseases pose a significant global health burden, requiring early detection and personalized treatment approaches. Traditional diagnostic approaches in periodontology often rely on a "one size fits all" approach, which may overlook the unique variations in disease progression and response to treatment among individuals. This narrative review explores the role of artificial intelligence (AI) and personalized diagnostics in periodontology, emphasizing the potential for tailored diagnostic strategies to enhance precision medicine in periodontal care. The review begins by elucidating the limitations of conventional diagnostic techniques. Subsequently, it delves into the application of AI models in analyzing diverse data sets, such as clinical records, imaging, and molecular information, and its role in periodontal training. Furthermore, the review also discusses the role of research community and policymakers in integrating personalized diagnostics in periodontal care. Challenges and ethical considerations associated with adopting AI-based personalized diagnostic tools are also explored, emphasizing the need for transparent algorithms, data safety and privacy, ongoing multidisciplinary collaboration, and patient involvement. In conclusion, this narrative review underscores the transformative potential of AI in advancing periodontal diagnostics toward a personalized paradigm, and their integration into clinical practice holds the promise of ushering in a new era of precision medicine for periodontal care.

Influence of residual pockets on periodontal tooth loss: A retrospective analysis

BACKGROUND

Individuals enrolled in supportive periodontal therapy (SPT) can still present with tooth loss due to periodontitis (TLP). There is limited evidence on the influence of residual pockets (RPc) and a defined "threshold" at which a patient's profile is set to be at high risk for TLP in the literature. Therefore, this study aimed to assess the influence of RPc on TLP and determine the prognostic performance of RPc compared to the staging and grading of periodontitis on TLP risk.

METHODS

Clinical data from 168 patients (3869 teeth) treated for periodontitis and receiving SPT for at least 10 years were evaluated in this retrospective study. TLP and the percentage of sites with RPc ≥ 5 mm or ≥6 mm per patient were collected. The prognostic performance of RPc was compared to the staging and grading of the disease on TLP using a multilevel Cox proportional hazard regression model.

RESULTS

Over a median follow-up of 25 years, 13.7% of teeth were lost, 4.6% of which were due to periodontitis. Most patients with TLP had ≥1 site with RPc ≥5 mm (90.8%) or ≥6 mm (77.6%). Multivariate multilevel Cox regression revealed that patients with >15% of sites with RPc ≥5 mm had a hazard ratio of 2.34, and grade C had a hazard ratio of 4.6 for TLP compared to RPc ≤4 mm/grade A. Grading exhibited the best discrimination and model fit.

CONCLUSION

Patients with RPc ≥5 mm at >15% of the sites are at risk for tooth loss. Grading and RPc ≥5 mm displayed very good predictive capability of TLP.

Tooth loss during supportive periodontal care: A prospective study

AIM

To assess periodontal stability and the association between tooth- and patient-related factors and tooth loss during supportive periodontal care (SPC).

MATERIALS AND METHODS

A prospective observational study was carried out on previously treated periodontitis patients followed up for 5 years in SPC. The risk profile (low, moderate, high) of each patient based on periodontal risk assessment (PRA) scoring at baseline was evaluated, and tooth loss rates were analysed.

RESULTS

Two hundred patients were included in the study, and 143 had 5-year follow-up data available for analysis. The overall annual tooth loss per patient was 0.07 ± 0.14 teeth/patient/year. Older age, smoking, staging and grading were associated with increased tooth loss rates. Most patients whose teeth were extracted belonged to the PRA high-risk group. Both PRA and a tooth prognosis system used at baseline showed high negative predictive value but low positive predictive value for tooth loss during SPC.

CONCLUSIONS

Overall, the tooth loss rate of periodontitis patients in this prospective cohort study under SPC in private practice was low. Both tooth-based and patient-based prognostic systems can identify high-risk cases, but their positive predictive value should be improved.

Cubic liquid crystals containing propolis flavonoids as in situ thermo-sensitive hydrogel depots for periodontitis treatment: Preparation, pharmacodynamics and therapeutic mechanisms

Propolis has a long ethnopharmacological history for oral periodontal diseases treatment. Propolis flavonoids are main active components for anti-inflammation and tissue protection. However, the intractable dissolution properties of propolis flavonoids and complex oral environment pose great challenges for periodontal delivery. In addition, the therapeutic mechanism as well as the therapeutic correlation of inflammation resolution and tissue regeneration remain unclear for propolis flavonoids. In this study, we constructed an in situ thermosensitive depot systems using total flavonoids from propolis-loaded cubic liquid crystals (TFP-CLC) hydrogel for periodontal delivery. TFP-CLC inhibited inflammatory cell infiltration, reactive oxygen species and the expression of inflammatory cytokines of NF-κB and IL-1β. In addition, alveolar bone and collagen were significantly regenerated after TFP-CLC administration according to micro-CT and immunohistochemistry. Mechanism studies suggested that TFP-CLC alleviated inflammation and promoted alveolar bone repair via regulating TLR4/MyD88/NF-κB p65 and RANK/NF-κB signaling pathways, respectively. Correlation analysis further confirmed that the inflammatory resolution produced by TFP-CLC could accelerate periodontal tissue regeneration. In summary, TFP-CLC is a promising multifunctional in situ thermo-sensitive hydrogel depots for periodontitis treatment.

The survival of periodontally treated molars in long-term maintenance: A systematic review and meta-analysis

AIM

This systematic review and meta-analysis aimed to determine the survival of periodontally treated molars during maintenance care and identify the risk factors associated with molar loss among patients with periodontitis who received professional periodontal therapy and maintenance.

MATERIALS AND METHODS

Longitudinal studies with a minimum follow-up duration of 5 years published until 28 August 2023 were retrieved from the following databases: the Cochrane Library, Embase, MEDLINE and Web of Science. All included studies reported data on molar retention. Meta-analysis was performed using Review Manager 5.4. A modified version of the Newcastle-Ottawa Scale was used to evaluate the study quality. Statistical results of analyses of the overall survival rate and molar loss are presented as estimated standardized mean differences, whereas the results of the analyses of risk factors are presented as risk ratios with 95% confidence intervals (95% CIs).

RESULTS

From among the 1323 potentially eligible reports, 41 studies (5584 patients, 29,908 molars retained at the beginning of maintenance therapy, mean follow-up duration of 14.7 years) were included. The pooled survival rate of the molars during maintenance therapy was 82% (95% CI: 80%-84%). The average loss of molars was 0.05 per patient per year (95% CI: 0.04-0.06) among the patients receiving long-term periodontal maintenance (PM) therapy. Fifteen factors were examined in this meta-analysis. Six patient-related factors (older age, lack of compliance, smoking, bruxism, diabetes and lack of private insurance) and five tooth-related factors (maxillary location, high probing pocket depth, furcation involvement, higher mobility and lack of pulpal vitality) were identified as risk factors for molar loss during maintenance therapy.

CONCLUSIONS

The findings of the present study suggest that the long-term retention of periodontally compromised molars can be achieved. The average number of molars lost per decade was <1 among the patients receiving long-term PM therapy. Older age, noncompliance, smoking, bruxism, diabetes, lack of private insurance coverage, maxillary location, furcation involvement, higher mobility, increase in the probing pocket depth and loss of pulpal vitality are strong risk factors for the long-term prognosis of molars.

Identifying predictors of the tooth loss phenotype in a large periodontitis patient cohort using a machine learning approach

OBJECTIVES

This study aimed to identify predictors associated with the tooth loss phenotype in a large periodontitis patient cohort in the university setting.

METHODS

Information on periodontitis patients and nineteen factors identified at the initial visit was extracted from electronic health records. The primary outcome is tooth loss phenotype (presence or absence of tooth loss). Prediction models were built on significant factors (single or combinatory) selected by the RuleFit algorithm, and these factors were further adopted by regression models. Model performance was evaluated by Area Under the Receiver Operating Characteristic Curve (AUROC) and Area Under the Precision-Recall Curve (AUPRC). Associations between predictors and the tooth loss phenotype were also evaluated by classical statistical approaches to validate the performance of machine learning models.

RESULTS

In total, 7840 patients were included. The machine learning model predicting the tooth loss phenotype achieved AUROC of 0.71 and AUPRC of 0.66. Age, periodontal diagnosis, number of missing teeth at baseline, furcation involvement, and tooth mobility were associated with the tooth loss phenotype in both machine learning and classical statistical models.

CONCLUSIONS

The rule-based machine learning approach improves model explainability compared to classical statistical methods. However, the model's generalizability needs to be further validated by external datasets.

CLINICAL SIGNIFICANCE

Predictors identified by the current machine learning approach using the RuleFit algorithm had clinically relevant thresholds in predicting the tooth loss phenotype in a large and diverse periodontitis patient cohort. The results of this study will assist clinicians in performing risk assessment for periodontitis at the initial visit.

ZEB1 interferes with human periodontal ligament stem cell proliferation and differentiation

BACKGROUND

Periodontitis can eventually contribute to tooth loss. Zinc finger E-box binding homeobox 1 (ZEB1) is identified as overexpressed in the gingival tissue of mice with periodontitis. This study is designed to decipher the mechanism of ZEB1's involvement in periodontitis.

METHODS

Human periodontal mesenchymal stem cells (hPDLSCs) were exposed to LPS to mimic the inflammation in periodontitis. Following ZEB1 silencing, FX1 (an inhibitor of Bcl-6) treatment or ROCK1 overexpression, cell viability, and apoptosis were analyzed. Alkaline phosphatase (ALP) staining, Alizarin red staining, RT-qPCR, and western blot were performed to evaluate osteogenic differentiation and mineralization. hPDLSCs were processed for luciferase reporter assay and ChIP-PCR to confirm the association between ZEB1 and ROCK1.

RESULTS

The induction of ZEB1 silencing resulted in reduced cell apoptosis, enhanced osteogenic differentiation, and mineralization. Nevertheless, these effects were significantly blunted by FX1. ZEB1 was confirmed to bind to the promoter sites of ROCK1 and regulate the ROCK1/AMPK. Whereas ROCK1 overexpression reversed the effects of ZEB1 silencing on Bcl-6/STAT1, as well as cell proliferation and osteogenesis differentiation.

CONCLUSION

hPDLSCs displayed decreased proliferation and weakened osteogenesis differentiation in response to LPS. These impacts were mediated by ZEB1 regulating Bcl-6/STAT1 via AMPK/ROCK1.

A retrospective analysis of the role of age and sex in outcomes of non-surgical periodontal therapy at a single academic dental center

The present study examined the role of age and sex in the outcomes of non-surgical periodontal therapy (NSPT). De-identified demographic and periodontal characteristics of patients who presented for baseline periodontal evaluation, NSPT, and periodontal re-evaluation were abstracted from electronic health records. Independent associations of age and sex with severe periodontitis defined as ≥ 5 mm clinical attachment loss (CAL) and ≥ 6 mm probing depth (PD) were determined using multinomial logistic regression. The null hypothesis was rejected at α < 0.05. A total of 2866 eligible subjects were included in the analysis. Significantly lower odds of CAL ≤ 4 mm than CAL ≥ 5 mm (reference) were observed in adults aged 35-64 (odds ratio, OR, 0.19; 95% confidence interval, CI 0.13, 0.29) and ≥ 65 years (OR 0.13; 95% CI 0.07, 0.25) compared to those aged 18-34 years. Odds of PD < 4 mm versus PD ≥ 6 mm (reference) were lower in adults aged 35-64 years than those aged 18-34 years (OR 0.71; 95% CI 0.55, 0.90) and higher in females compared to males (OR 1.67; 95% CI 1.14, 2.44). These results suggest more compromised post-NSPT outcomes in older adults and males compared to the respective populations and highlight the need for personalized therapeutic strategies in these populations.

Assessing the association between tea intake and risk of dental caries and periodontitis: a two-sample Mendelian randomization study

Tea is an indispensable beverage in people's daily life. However, the relationship between tea intake and dental caries and periodontitis is controversial. We extracted datasets for tea intake and oral diseases from genome-wide association studies (GWASs) conducted by the UK Biobank and the Gene Lifestyle Interactions in Dental Endpoints consortium. We selected 38 single-nucleotide polymorphisms (SNPs) significantly associated with tea intake as instrumental variables (IVs) (P < 5.0 × 10-8). Mendelian randomization (MR) was performed to investigate the potential causality between tea intake and caries and periodontitis. Multivariable Mendelian randomization (MVMR) analyses were utilized to estimate causal effects of tea intake on risk of caries and periodontitis after adjusting for smoking, body mass index (BMI), and socioeconomic factors. The results showed that higher tea intake was suggestively associated with fewer natural teeth (β = - 0.203; 95% CI = 0.680 to 0.980; P = 0.029) and higher risk of periodontitis (OR = 1.622; 95% CI = 1.194 to 2.205; P = 0.002). After Bonferroni correction, the causality of tea intake on periodontitis remained significant. The significance of periodontitis disappeared after adjusting for the socioeconomic factors in MVMR (OR = 1.603; 95% CI = 0.964 to 2.666; P = 0.069). Tea intake had no association with risk of caries. Statistical insignificance of the heterogeneity test and pleiotropy test supported the validity of the MR study. Our results provide insight into the potential relationship between tea intake and oral diseases from a dietary lifestyle perspective, which may help prevent oral diseases.

Mouse gingival single-cell transcriptomic atlas identified a novel fibroblast subpopulation activated to guide oral barrier immunity in periodontitis

Periodontitis, one of the most common non-communicable diseases, is characterized by chronic oral inflammation and uncontrolled tooth supporting alveolar bone resorption. Its underlying mechanism to initiate aberrant oral barrier immunity has yet to be delineated. Here, we report a unique fibroblast subpopulation activated to guide oral inflammation (AG fibroblasts) identified in a single-cell RNA sequencing gingival cell atlas constructed from the mouse periodontitis models. AG fibroblasts localized beneath the gingival epithelium and in the cervical periodontal ligament responded to the ligature placement and to the discrete topical application of Toll-like receptor stimulants to mouse maxillary tissue. The upregulated chemokines and ligands of AG fibroblasts linked to the putative receptors of neutrophils in the early stages of periodontitis. In the established chronic inflammation, neutrophils, together with AG fibroblasts, appeared to induce type 3 innate lymphoid cells (ILC3s) that were the primary source of interleukin-17 cytokines. The comparative analysis of Rag2-/- and Rag2-/-Il2rg-/- mice suggested that ILC3 contributed to the cervical alveolar bone resorption interfacing the gingival inflammation. We propose the AG fibroblast-neutrophil-ILC3 axis as a previously unrecognized mechanism which could be involved in the complex interplay between oral barrier immune cells contributing to pathological inflammation in periodontitis.

Food preferences and periodontal status of adults assisted by a public health care system

This study aimed to investigate the relationship between food choices and periodontal health status (PHS) in adults who receive care through a public health system. We evaluated food preferences and periodontal status in a sample of 442 individuals with at least eight natural teeth. We employed the Food Frequency Questionnaire (FFQ) to assess food choices and the Periodontal Screening and Recording (PSR) instrument to evaluate periodontal health status during clinical appointments. Fisher's discriminant analysis was used to differentiate the participants according to PHS severity within three age-ranges (18-39; 40-59 and > 60 years-old). The results showed that the prevalence of overweight/obesity was high in all age groups (above 65%), and BMI increased with age, accompanied by an increase in the prevalence of chronic diseases. A lower preference for natural foods and a higher intake of processed and ultra-processed foods, along with a high waist circumference and diabetes, were associated with a poorer periodontal health status. In the 18-39 age group, a lower waist circumference was associated with healthier periodontal status. In the 40-59 age group, a worse periodontal status resulted from a higher frequency of diabetes, lower intake of green leafy vegetables, olive oil, and fruit, and higher intake of industrialized juice. Conversely, a healthier periodontal status was associated with a lower frequency of diabetes and higher intake of fruit and vegetables. In the > 60age group, the worst periodontal status was associated with male sex. Overall, the study highlights the possible beneficial role of a healthy diet in maintaining periodontal health, particularly for those who receive care through a public health system.

Clinical periodontal diagnosis

Periodontal diseases include pathological conditions elicited by the presence of bacterial biofilms leading to a host response. In the diagnostic process, clinical signs such as bleeding on probing, development of periodontal pockets and gingival recessions, furcation involvement and presence of radiographic bone loss should be assessed prior to periodontal therapy, following active therapy, and during long-term supportive care. In addition, patient-reported outcomes such as increased tooth mobility, migration, and tilting should also be considered. More important to the patient, however, is the fact that assessment of signs of periodontal diseases must be followed by an appropriate treatment plan. Furthermore, it should be realized that clinical and radiographic periodontal diagnosis is based on signs which may not reflect the presence of active disease but rather represent the sequelae of a previous bacterial challenge. Hence, the aim of the present review is to provide a summary of clinical and radiographic diagnostic criteria required to classify patients with periodontal health or disease.

Longevity of teeth in patients susceptible to periodontitis: Clinical outcomes and risk factors associated with tooth loss after active therapy and 30 years of supportive periodontal care

AIM

(i) To evaluate the efficacy of active periodontal therapy supplemented by supportive periodontal care (SPC) in retaining dentition during a 30-year follow-up period in patients susceptible to periodontitis, and (ii) to assess the prognostic factors associated with tooth loss.

MATERIALS AND METHODS

One-hundred and fifty-four patients with periodontitis, retrospectively classified as stage I-IV and grade B-C periodontitis, treated between 1984 and 1986 in a private practice, were enrolled in this study. After periodontal assessment, patients received non-surgical treatment followed by surgical periodontal therapy, orthodontic treatment, and tooth-splinting, where appropriate. SPC consisted of a strict recall programme every 3-6 months over a 30-year period. Recurrences were treated either with subgingival root planing or flap surgery. Dental and periodontal variables were measured at baseline (T0), end of active therapy (T1), and after 25 (T2) and 30 (T3) years. Generalized mixed models were analysed to assess the prognostic factors associated with and survival analyses for tooth loss.

RESULTS

Data on 154 patients (4083 teeth) were available at baseline (T0). Teeth considered unworthy of treatment were extracted during active therapy (160, 3.9%) and at re-assessment (13, 0.3%; T1). After 25 years of SPC, 140 teeth out of 3910 in 154 patients (3.6%) were lost (24 in 18 patients for periodontal reasons). Between 25 and 30 years, 20 patients (482 teeth) dropped out, and 61 teeth (2%) were lost (15 in 14 patients for periodontal reasons). Overall, 201 teeth (5.1%) were lost (39 for periodontal reasons) in 30 years of SPC. Generalized mixed models showed that stage III or stage IV periodontitis was associated with greater tooth loss during SPC compared to stage I or stage II (OR = 2.10; p = .048). Generalized periodontitis showed a statistically significant OR = 3.24 (p = .016) compared to the localized one. In SPC (T1-T3), age (p = .011), gender (male; p = .038), molar teeth (p = < .001), T0 and T1 pocket depth (p = < .001), tooth mobility grades 2 (p = .018) and 3 (p = .050), T0 and T1 bone loss (p = < .001), and presence of a root canal treatment (p = < .001) and a crown (p = .009) were statistically significantly associated with tooth loss.

CONCLUSION

(i) Periodontal therapy and a stringent SPC are effective in maintaining most of the teeth in patients with moderate/advanced periodontitis for 30 years, and (ii) age, gender, molar teeth, pocket depth, bone loss, and the presence of a root canal treatment and a crown are prognostic factors associated with tooth loss.

Risk factors for tooth loss and progression of periodontitis in patients undergoing periodontal maintenance therapy

AIM

The aim of this study was to investigate patient- and tooth-level factors that may predict tooth loss and periodontitis progression in patients who have undergone at least 5 years of periodontal maintenance.

MATERIALS AND METHODS

In this retrospective cohort study, 135 patients were examined after active periodontal therapy (APT) and periodontal maintenance for 5.09-8.65 years (mean 6.16 ± 0.74 years). Regression models were applied to identify risk factors associated with tooth loss and disease progression.

RESULTS

Stage IV periodontitis (incidence rate ratio [IRR] = 4.61; 95% confidence interval, CI [2.97-7.18], p < .001), the presence of ≥5 sites with probing pocket depth (PPD) ≥5 mm at the end of APT (IRR = 2.04; 95% CI [1.32-3.20], p < .01), and residual PPD ≥7 mm at the end of APT (odds ratio [OR] = 3.01; 95% CI [1.14-7.94], p < .05) were risk factors for tooth loss. Residual PPDs of 5 mm (OR = 2.02; 95% CI [1.20-3.40], p < .01) and 6 mm (OR = 2.41; 95% CI [1.22-4.76], p < .05) at the end of APT were risk factors for disease progression. Above 3 mm, each 1 mm increase in maximum PPD/clinical attachment loss was associated with an increased risk of tooth loss and disease progression.

CONCLUSIONS

Stage IV periodontitis is associated with an increased risk of tooth loss. Teeth with PPD ≥5 mm at the end of APT are at risk of periodontitis progression or tooth loss.

Furcation-involved molar teeth - part 2: management and prognosis

Furcation-involved molars are a common presentation in general dental practice. Teeth with increasing degrees of furcation involvement are at a higher risk of requiring extraction. This second article reviews management and prognosis of furcation-involved molar teeth. An improved understanding of how to appropriately manage these teeth can result in improved outcomes for patients.

Periodontal disease progression and gene polymorphisms: results after 3 years of active periodontal treatment

BACKGROUND

Although non-surgical periodontal treatment is considered the gold standard, a subgroup of patients displays recurrence/progression of periodontitis after treatment. The aim of the present prospective study was to assess the effect of IL-6 -572 G/C and IL-10 -592 C/A gene polymorphisms on the risk of disease recurrence/progression at 3 years following non-surgical periodontal treatment.

METHODS

Thirty-seven patients diagnosed with chronic periodontitis received oral hygiene instructions and non-surgical periodontal treatment and were monitored for 3 years. All individuals were clinically evaluated for PPD, CAL and BOP at baseline and 3 years. Based on the clinical findings at 3 years, all subjects were considered either "at risk" or "not at risk" of periodontal disease progression based on specific criteria. Blood samples were collected at baseline and genotyping of the polymorphisms in IL-6 (rs1800796) and IL-10 (rs1800872) genes were performed by PCR.

RESULTS

Following DNA separation and genotyping, 70.3% of the patients were homozygous carriers of the IL-6 -572G and 45.9% were carriers of the IL-10 -592A allele. Individuals at risk of disease progression ranged from 16.2% to 56.8% based on the criteria used. IL-6 -572 G/C and IL-10 -592 C/A polymorphisms were not associated with an increased risk of further disease progression (P>0.05) when the three criteria were examined. All examined periodontal clinical measures were significantly improved (P<0.05) after treatment. Males showed a significantly higher risk of disease progression than females when full-mouth BOP ≥30% was considered (P=0.008).

CONCLUSIONS

Within the limitations of this 3-year prospective study, individuals susceptible to periodontal disease as determined by the presence of the IL-6 -572GG genotype or the IL-10 -592A allele were not associated with an increased risk of further disease progression and the potential need for further treatment following non-surgical periodontal treatment. Males were more prone to be at risk of disease progression than females.

Clinical, Histological, and Radiological Outcomes of Sinus Floor Elevation Using a New Approach before Extraction of Periodontally Hopeless Maxillary Molars: A Case Report with 3-year Follow-Up

Introduction. This report is the first to present a case with 3-year follow-up, in which sinus floor elevation was performed before extraction of periodontally hopeless teeth, in order to shorten the edentulous interval between extraction and loading of implants and improve the patient’s quality of life. Case Presentation. After a series of initial and supportive periodontal therapies, the lateral window was created at the apices of the hopeless teeth, followed by grafting of bone substitute and membrane material at the sinus floor. The tooth was preserved for 13 months prior to extraction followed by immediate implant placement. The patient is satisfied with the oral function partially retained during the treatment period. Predominance of new bone was detected by histologic analysis. The available bone height was augmented from 1–2 to 12–14 mm with little resorption (less than 2 mm of height) after 3 years of follow-up. The dental implant is in good condition without obvious signs of peri-implantitis or mobility after 3 years of loading. Discussion. The feasibility of modified sinus floor elevation (MSFE) could be seen in the current case. The potential benefit of MSFE may include shortening the edentulous interval, facilitating bone regeneration, and providing a chance for immediate implant placement. However, further clinical case evaluations and controlled studies are required to determine indications, effectiveness, and safety of such augmentation procedures.

Intraoral Scanners for In Vivo 3D Imaging of the Gingiva and the Alveolar Process

This study aimed to assess the reliability of two intraoral surface scanners for the representation of the alveolar process in vivo. Complete maxillary scans (CS 3600, Carestream and TRIOS 3, 3Shape) were repeatedly obtained from 13 fully dentate individuals. Scanner precision and agreement were tested using 3D surface superimpositions on the following reference areas: the buccal front teeth area, the entire dental arch, the entire alveolar process, or single teeth by applying an iterative closest point algorithm. Following each superimposition, the mean absolute distance (MAD) between predefined 3D model surfaces was calculated. Outcomes were analyzed through non-parametric statistics and the visualization of color-coded distance maps. When superimpositions were performed on the alveolar process, the median scanner precision was below 0.05 mm, with statistically significant but negligible differences between scanners. The agreement between the scanners was approximately 0.06 mm. When single-tooth superimpositions were used to assess the precision of adjacent alveolar soft-tissue surfaces, the median error was 0.028 mm, and there was higher agreement between the scanners. The in vivo reliability of the intraoral scanners in the alveolar surface area was high overall. Single-tooth superimpositions should be preferred for the optimal assessment of neighboring alveolar surface areas relative to the dentition.

Association of lipid profile and reported edentulism in the elder population: data from the China Health and Retirement Longitudinal Study

Objectives

Relationship between lipid profile and periodontitis has been reported. However, the association between lipid parameters and edentulism is unclear. This study aimed to investigate the association between lipid profile and reported edentulism in the elder population using a national cohort.

Methods

A total of 3 100 participants aged 65 or above were enrolled in 2011 from China Health and Retirement Longitudinal Study, which was a national population-based survey. We used adjusted logistics models to investigate the relationship between lipid profile and reported edentulism before and after propensity score matching.

Results

The mean (SD) age was 71.96 (5.63) years, and 1 581 (51.0%) were men. There were 254 (8.2%) individuals reporting edentulism, and the low-density lipoprotein cholesterol (LDL-C) was significantly higher in the reported edentulism group, compared with the non-edentulism (122.48 vs. 116.91 mg/dl, P = 0.015). In the multivariable model, LDL-C was significantly associated with a higher odds of reported edentulism (adjusted OR [95% CI], 1.004 [1.001–1.008]). In the matched population, LDL-C, non high-density lipoprotein cholesterol, remnant cholesterol, total cholesterol and triglycerides were positively associated with reported edentulism, while HDL-C was negatively associated.

Conclusions

Lipid profiles are probably associated with edentulism, indicating the interaction between oral health and metabolic status in the elder population.

Association of Diet-Related Systemic Inflammation with Periodontitis and Tooth Loss: The Interaction Effect of Diabetes

Diet is an important factor that can affect inflammatory processes. Diet-related systemic inflammation is closely linked to periodontitis and tooth loss. However, the role that systemic conditions play in influencing this association remains unclear. A cross-sectional analysis was conducted using the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2014. Diet-related systemic inflammation was assessed by the Dietary Inflammatory Index (DII). Multivariate Cox regression models were used to investigate the association between DII and periodontal results, including total periodontitis, tooth loss, severe tooth loss, and the number of teeth lost. The interaction effects between DII and established covariates were tested. Higher DII scores, corresponding to a higher pro-inflammatory potential of the diet, were associated with an increased risk of periodontitis and tooth loss among the 10,096 eligible participants. There was an interaction between diabetes and DII on total periodontitis (p = 0.0136). No significant interaction effect was detected between DII and other established covariates. Participants who consumed an anti-inflammatory diet, and did not have diabetes, experienced the lowest risks of periodontitis and tooth loss. However, in the context of diabetes, the efficacy of such a diet may be weakened or even eliminated. Dietary interventions to manage oral health problems may need to take the individual's metabolic condition into account.

IL-18 Gene rs187238 and rs1946518 Polymorphisms and Expression in Gingival Tissue in Patients with Periodontitis

Periodontitis is a chronic disease with disturbed balance between the immune and inflammatory response of the host to bacteria. Many studies have shown that proinflammatory cytokines play a significant role in the pathogenesis of periodontal disease. In this study, we examined the association between the IL-18 gene rs187238 and rs1946518 polymorphisms and periodontitis in non-smoking and smoking patients. This study enrolled 200 patients with periodontitis (130 non-smokers and 70 smokers) and 156 control subjects (124 non-smokers and 32 smokers). There were no statistically significant differences in the distribution of the rs187238 and rs1946518 IL-18 genotypes and alleles between patients with periodontitis and control subjects, between smoking patients with periodontitis and smoking control subjects, and between non-smoking patients with periodontitis and non-smoking control subjects. There were no statistically significant differences in clinical parameters in relation to the IL18 rs187238 genotypes. In patients with the IL18 rs1946518 GG genotype, we observed increased values of bleeding on probing (BoP) and periodontal probing depth (PPD), compared to subjects with the TT genotype. In patients with periodontitis, we observed statistically significant decreased expression of the IL-18 gene in comparison with healthy subjects (0.231 ± 0.163 vs. 0.663 ± 0.197, p = 0.0008). In addition, the IL-18 gene expression in gingival tissue in patients with periodontitis correlated positively with the number of remaining teeth. The results of our study suggest that the IL-18 rs187238 and rs1946518 polymorphisms are not significant risk indicators of periodontitis in our population. However, in patients with the IL18 rs1946518 GG genotype, we observed increased values of BoP and PPD, compared to subjects with the TT genotype. In addition, in gingival tissue of patients with periodontitis, we have detected decreased expression of IL-18. The gingival expression of IL-18 in patients with periodontitis correlated positively with number of remaining teeth. The above results suggest that IL-18, in addition to its pro-inflammatory effects in periodontal disease, may also exhibit protective properties.

A 3D-printed molybdenum-containing scaffold exerts dual pro-osteogenic and anti-osteoclastogenic effects to facilitate alveolar bone repair

The positive regulation of bone-forming osteoblast activity and the negative feedback regulation of osteoclastic activity are equally important in strategies to achieve successful alveolar bone regeneration. Here, a molybdenum (Mo)-containing bioactive glass ceramic scaffold with solid-strut-packed structures (Mo-scaffold) was printed, and its ability to regulate pro-osteogenic and anti-osteoclastogenic cellular responses was evaluated in vitro and in vivo. We found that extracts derived from Mo-scaffold (Mo-extracts) strongly stimulated osteogenic differentiation of bone marrow mesenchymal stem cells and inhibited differentiation of osteoclast progenitors. The identified comodulatory effect was further demonstrated to arise from Mo ions in the Mo-extract, wherein Mo ions suppressed osteoclastic differentiation by scavenging reactive oxygen species (ROS) and inhibiting mitochondrial biogenesis in osteoclasts. Consistent with the in vitro findings, the Mo-scaffold was found to significantly promote osteoblast-mediated bone formation and inhibit osteoclast-mediated bone resorption throughout the bone healing process, leading to enhanced bone regeneration. In combination with our previous finding that Mo ions participate in material-mediated immunomodulation, this study offers the new insight that Mo ions facilitate bone repair by comodulating the balance between bone formation and resorption. Our findings suggest that Mo ions are multifunctional cellular modulators that can potentially be used in biomaterial design and bone tissue engineering.

Smoking Cessation on Periodontal and Peri-Implant Health Status: A Systematic Review

Since smoking is considered among the main risk factors for the onset and progression of periodontitis and peri-implantitis, the present systematic review aimed to evaluate the effect of smoking cessation on clinical, radiographic, and gingival crevicular periodontal parameters around natural teeth and dental implants in ex-smokers compared to current and non-smokers. The study protocol was developed based on the PRISMA guidelines, the research question was formulated according to the PICO model, and the literature search was conducted through PubMed/MEDLINE, Cochrane library, and BioMed Central databases. From the 916 title/abstracts initially identified, seven articles were included in the present systematic review and assessed for quality through the ROBINS-I tool. Reported findings on clinical and crevicular periodontal parameters around natural teeth were contrasting when comparing ex-smokers to current and non-smokers; thus, individualized recommendations for previous smoker periodontal patients are currently lacking. No data on radiographic parameters were retrieved. Similarly, data on periodontal parameters around dental implants were not available, highlighting the need for focused investigations assessing the role of both smoking habit and cessation on peri-implant health status and responsiveness to treatment.

The use of interdental cleaning devices and periodontal disease contingent on the number of remaining teeth in Korean adults

This study aimed to investigate the effect of interdental brushes and dental floss on the prevention of periodontitis in participants with ≥ 20 or < 20 remaining teeth by using the Korea National Health and Nutrition Examination Survey 2016-2018. Data from 11,614 participants were analysed using multivariate logistic regression after adjusting for sociodemographic factors (age and sex), socioeconomic factors (level of education and individual income), oral health-related variables (daily toothbrushing), and systemic health-related variables (smoking, diabetes, and obesity). The adjusted odds ratio (AOR) showed statistically significant results for both floss (AOR, 1.41; 95% confidence interval (CI) 1.22-1.64) and interdental brushes (AOR, 1.16; 95% CI 1.01-1.34). However, no significant difference was found in the subjects with fewer than 20 teeth. The subgroup analysis showed that interdental brushes had a significant preventive effect on women who had more than 20 teeth. Among participants with fewer than 20 teeth, interdental brush users had more periodontitis in men. Regarding those with more than 20 teeth, health inequality was alleviated when floss and interdental brushes were used. The bottom line is that the effect of preventing periodontitis in interdental brushes and dental floss was more evident in participants with ≥ 20 remaining teeth rather than in participants with < 20 remaining teeth.

Clinical and Biochemical Effects of Smoking on Non-Surgical Periodontal Treatment in Grade III Stage C Periodontitis Patients

Objective: The purpose of this study was to evaluate the effect of smoking on clinical parameters and the serum and saliva levels of RANKL, OPG, and IL-34 in periodontitis stage III grade C (III-C) patients after non-surgical periodontal treatment (NSPT). Methods: A total of 60 subjects, 40 periodontitis-III-C patients (20 smokers and 20 non-smokers) and 20 non-smoker periodontally healthy individuals, were included. All clinical periodontal parameters were recorded, and unstimulated saliva and serum samples were collected from all patients at baseline, but at 1 and 3 months only from periodontitis patients (N=40). Saliva and serum levels of RANKL, OPG, and IL-34 were analyzed by ELISA. Results: At baseline only whole mouth probing depth (PD) and percent of sites with PD>5mm were higher in smokers than non-smoker periodontitis patients (p