AIMS:Periodontitis among nursing home residents is increasing as more older adults retain their dentition. Evidence on the impact of periodontal therapy on their oral microbiota is limited. We aimed to assess the effect of outreach-based supra- and sub-gingival instrumentation on the periodontal microbiome. MATERIALS AND METHODS:In this secondary analysis of an RCT, 36 residents (mean age 85 ± 6 years) with periodontitis had been randomised to supra- and sub-gingival instrumentation (mean duration 14.3 ± 5.2 min) or a 3-month control. Supragingival and subgingival plaque samples were collected at baseline and 3 months. Bacterial 16S rRNA sequencing and mixed-effects modelling were used to assess alpha/beta diversity, dysbiosis index and differential abundance between groups over time. RESULTS:The intervention group showed clinical improvements, with bleeding on probing decreasing from 45% ± 20% to 35% ± 16% and probing pocket depth decreasing from 4.5 ± 0.5 to 4.0 ± 0.5 mm. Dysbiosis was reduced compared with controls (β = -1.97, p = 0.0008). Beta-diversity confirmed microbial shifts (R2 = 0.0075, p = 0.025), characterised by decreases in differential abundance of Treponema and Fretibacterium and increases in Lactobacillus and Actinomyces. CONCLUSIONS:A pragmatic outreach-based supra- and sub-gingival instrumentation reduced microbial dysbiosis and improved periodontal parameters in institutionalised older adults, supporting its effectiveness in nursing home care. TRIAL REGISTRATION:German Clinical Trials Register (DRKS) registration number: DRKS00029392.
AIM:This study examined the associations of periodontal status with incident dementia and its subtypes in a Japanese community. MATERIALS AND METHODS:The 1396 participants aged ≥ 60 years without dementia were followed for 10 years. Periodontal status at baseline and 5 years was assessed using mean probing pocket depth (PPD), clinical attachment level (CAL) and percentage of bleeding on probing (%BOP), categorized into quartiles. Cox proportional hazards and time-varying Cox models were used. RESULTS:During follow-up, 267 participants developed dementia; 194 and 51 had Alzheimer's disease (AD) and vascular dementia (VaD), respectively. Compared with the lowest quartile, the highest quartiles of PPD, CAL and %BOP at baseline were associated with increased dementia risk (hazard ratio 1.72 [95% confidence interval 1.18-2.46], 1.59 [1.07-2.38] and 1.56 [1.09-2.22], respectively, all p for trend < 0.05). Elevated %BOP was associated with AD risk (p for trend = 0.023). Higher PPD tended to be associated with VaD (p for trend = 0.076). Similar associations for all-cause dementia were observed in time-varying Cox analyses. CONCLUSIONS:Poor periodontal status was associated with dementia in older Japanese adults. These findings highlight the potential public health importance of preventing periodontitis to reduce the risk of dementia.
AIM:To examine whether childhood famine exposure affects late-life edentulism using natural experiments from Asia, Europe and America. MATERIALS AND METHODS:We utilised historical famines as exogenous shocks. Data were pooled from 10 population-based studies across eight countries (165,586 participants). Because the famine-exposed cohort is older at survey than the comparison cohort, we separated famine exposure from the birth-cohort age gradient using a regression discontinuity in time, an interrupted time series, a region-of-birth famine-intensity difference-in-differences, a pre-famine comparison cohort and applied negative controls. RESULTS:The crude positive association (risk ratio [RR] 1.69) was eliminated after adjustment for current age (RR 1.07, 95% confidence interval (CI) 0.92-1.23), and the famine cohort did not differ from the older pre-famine cohort (RR 0.97). The regression discontinuity (+0.13% points, 95% CI: -1.50 to +1.77), interrupted time series (-4.01% points, p = 0.15) and the region-of-birth difference-in-differences in the two Chinese cohorts (unadjusted, both p ≥ 0.07) were null, as were all negative controls. CONCLUSIONS:Once the birth-cohort age gradient is accounted for, childhood famine exposure shows no detectable effect on late-life edentulism; the crude positive association is largely explained by age confounding, which cross-sectional famine-cohort comparisons do not address.
AIM:To investigate the mechanism of the autotaxin/lysophosphatidic acid (ATX/LPA) axis in regulating osteoclastogenesis and inflammation in periodontitis. MATERIALS AND METHODS:The expression levels and clinical relevance of the ATX/LPA axis were studied by collecting clinical samples including gingiva and gingival crevicular fluid from periodontitis patients and healthy subjects. Subsequently, macrophage Atx knockout (CKO) mice and bone marrow-derived macrophages (BMDMs) were generated to investigate the role of the ATX/LPA axis in modulating osteoclastogenesis and inflammation during periodontitis development. Finally, the ATX inhibitor PF8380 was used to explore a promising therapeutic strategy for controlling periodontitis. Histomorphological, molecular and cytological analyses were performed using RNA sequencing, real-time polymerase chain reaction, immunofluorescence, immunohistochemistry, enzyme-linked immunosorbent assay, micro-computed tomography, haematoxylin and eosin staining, tartrate-resistant acid phosphatase staining, actin filament staining, pit resorption assay and flow cytometry. RESULTS:The expression of the ATX/LPA axis was more enhanced in the periodontitis group than that in the health group and was positively correlated with the severity of periodontitis. Subsequently, CKO mice showed milder inflammation and less bone resorption than wild-type (WT) mice of periodontitis. Following Porphyromonas gingivalis LPS stimulation, CKO-BMDMs were markedly suppressed in osteoclastogenesis and inflammation compared to WT-BMDMs. In addition, the mechanism of the ATX/LPA axis in regulating osteoclastogenesis may act synergistically with activated inflammation-related pathways by RNA sequencing. Finally, we used the ATX inhibitor PF8380 and found that PF8380 alleviated alveolar bone resorption in periodontitis mice and modulated BMDMs' osteoclast differentiation and phenotypic transformation. CONCLUSION:The ATX/LPA axis plays a significant regulatory role in osteoclastogenesis and osteoclast activity and may enable selective control of bone loss and inflammation in periodontitis. Therefore, targeting ATX inhibition may represent a novel therapeutic strategy for preventing alveolar bone resorption and periodontal inflammation in patients with periodontitis.
AIM:To characterise multi-kingdom salivary microbiome profiles across clinically defined periodontal states and identify stage-specific taxonomic and functional alterations using shotgun metagenomic sequencing. MATERIALS AND METHODS:In this cross-sectional study, 204 adults (mean age 40.3 ± 7.6 years) from the SECRETO study (NCT01934725) underwent clinical and radiographic oral examinations and were classified into six periodontal groups: periodontal health, localised gingivitis, generalised gingivitis, gingivitis with pockets, mild periodontitis (Stages I-II) and severe periodontitis (Stages III-IV). Saliva samples were analysed using shotgun metagenomic sequencing to evaluate microbial diversity, taxonomic composition and functional pathways. RESULTS:Beta diversity differed between periodontal health and the different disease states (Bray-Curtis: p = 0.049; Jaccard: p = 0.043). Gingivitis with pockets and severe periodontitis showed a significant enrichment of disease-associated species Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Porphyromonas endodontalis, Fusobacterium nucleatum and Parvimonas micra. Among non-bacterial taxa, Candida, Moineauvirus, Pyricularia and Roseolovirus were the predominant genera. A composite metagenomic classifier showed high discriminative performance for gingivitis with pockets (AUC = 0.90; 95% CI: 0.770-1.000) and severe periodontitis (AUC = 0.865; 95% CI: 0.762-0.968). CONCLUSION:Salivary multi-kingdom microbiome transitions closely reflect the progression of periodontal disease and provide promising biomarkers for identifying at-risk individuals.
OBJECTIVE:To assess the impact of keratinized mucosa width (KMW) and mucosal thickness (MT) on peri-implant conditions over 25 years in patients with adequate oral hygiene enrolled in regular supportive peri-implant care. METHODS:Partially edentulous patients rehabilitated with tissue-level implants were clinically and radiographically evaluated by calibrated examiners. Patient-reported brushing discomfort was recorded, and associations with variables of interest were analysed. RESULTS:A total of 149 patients, 235 implants, with a mean follow-up of 25.4 ± 3 years, were included. Peri-implantitis prevalence was 11.1%, 0% and 7.1% in the 0-mm, < 2-mm and ≥ 2-mm KMW groups, respectively (p = 0.98). Sites with 0 mm KMW showed significantly greater crestal bone loss (CBL) than < 2 mm (-0.28 mm) and ≥ 2 mm (-0.40 mm) (p = 0.01). Absence of KMW was associated with an increased risk of peri-implant soft-tissue dehiscence (PSTD) and implant platform visibility (p ≤ 0.01). No significant differences were observed for probing depth (PD), bleeding on probing (BOP), plaque index or peri-implant diseases (p > 0.05). MT was not associated with CBL, PD, BOP, suppuration on probing (SOP) or peri-implant diseases (p > 0.05). Thin MT (< 2 mm) was linked to increased PSTD (p = 0.005), greater implant platform visibility (p = 0.04) and lower plaque index (p = 0.01). Brushing discomfort was reported in 11.4% of sites with 0 mm KMW, compared with 3.4% and 2.4% in the < 2 mm and ≥ 2 mm groups, respectively, with no significant associations across KMW or MT groups (p > 0.05). CONCLUSIONS:KMW was associated with long-term peri-implant tissue stability, whereas thin MT was primarily associated with an increased risk of PSTD. Neither KMW nor MT was significantly associated with long-term brushing discomfort.
AIMS:To evaluate wound-healing progression among platelet-rich fibrin (PRF), plasma rich in growth factors (PRGF), a collagen-based wound dressing (CS = collagen substitute) and spontaneous healing (control), assessed by percentage of remaining open wound area and patient-reported pain. MATERIALS AND METHODS:Twenty participants each received four standardised palatal wounds (6 mm × 3 mm) and were randomly assigned to PRF, PRGF, a collagen substitute or spontaneous healing as control. All dressings were secured with criss-cross sutures. Standardised clinical photographs and pain assessments were obtained at baseline and on postoperative days 2,5,7,9, 12 and 14. Parametric and nonparametric models for longitudinal data were used to compare outcomes, accounting for within-subject correlation of repeated measurements. RESULTS:Open wound area decreased across all groups throughout the 14-day period. Some defects enlarged transiently at Day 2, and the greatest differences between the groups were observed on Day 7 (35.7%-47.0% of wound remaining). Pain scores decreased significantly over time in all groups, with no statistically significant differences between treatments (p > 0.05). Anterior defects tended to be perceived as more painful than posterior defects. CONCLUSIONS:Spontaneous healing resulted in slightly faster reduction of remaining open wound area than PRF, PRGF or the collagen substitute, with comparable postoperative pain levels. In standardised defects in healthy individuals, PRF, PRGF and collagen substitutes demonstrate minimal additional benefit for soft-tissue healing. Further studies are warranted to determine whether benefits emerge in larger wounds or in patients with compromised healing.
AIM:To critically appraise the methodological quality and historical evolution of prognostic models for periodontitis. MATERIALS AND METHODS:A systematic search was conducted in three databases. Eligible studies were classified as conceptual tools, category-based tools and data-driven models. Category-based and data-driven models were evaluated with PROBAST. Risk of bias (ROB) was compared across four domains: Participants, Predictors, Outcome and Analysis. RESULTS:Twenty-seven studies were included. Prognostic methods evolved from qualitative risk categories and expert-based classifications towards quantitative, individualised probability estimates generated through multivariable statistical and machine-learning models, alongside progressive improvements in outcome definition, prediction time and risk expression formats. Conceptual tools were not evaluable under PROBAST due to the absence of empirical data. Category-based tools showed limitations in predictor handling and validation rather than bias per se. Data-driven models demonstrated progressive refinement: earlier studies lacked consistent validation, whereas recent models more frequently report internal validation, calibration metrics and external validation. However, all studies except one were classified as high ROB. Domain-level assessment showed strengths in the Participants domain but persistent limitations in the Analysis domain. Methodological improvements after TRIPOD were modest. CONCLUSION:Prognostic models reflect distinct methodological profiles across design type. Conceptual and category-based frameworks remain clinically relevant historically, while data-driven models represent the contemporary standard but retain important methodological gaps. TRIAL REGISTRATION:PROSPERO number: CRD42024525505.
AIM:To clinically and radiologically evaluate the healing capacity of intrabony periodontal defects treated with guided tissue regeneration (GTR) with or without the combination of orthodontic tooth movement (OTM). MATERIALS AND METHODS:Thirty-four individuals presenting with periodontal intrabony defects (IDs) and pathological tooth migration (PTM) were included in this randomised controlled clinical trial. Extended, coronally advanced flaps and GTR (collagen membrane and bovine bone mineral) were used to treat IDs. After surgery, patients were randomly allocated to either the test group (n = 17) with an early (1 week postoperatively) initiation of OTM or the control group (n = 17) without any tooth movement. Outcome variables comprised changes in clinical attachment level (CAL), probing pocket depth (PPD), gingival recession (GR), probing bone level and intrabony component (IC). RESULTS:Both groups yielded statistically significant CAL gain (4.0 ± 2.0 mm in the test group and 4.4 ± 1.3 mm in the control group) and PPD reduction (3.9 ± 1.4 and 4.9 ± 1.7 mm, respectively) as well as IC reduction. However, only the control group showed a significant increase in GR and crestal bone loss from baseline to the endpoint. The change in IC was -4.3 ± 2.0 mm in the test group and -4.6 ± 1.8 mm in the control group, corresponding to 66% and 64.5% intrabony fill, respectively. All evaluated parameters showed comparable changes between the two groups, with no evidence of clinically meaningful differences. CONCLUSIONS:GTR combined with OTM resulted in similar clinical endpoint parameters after 9 months of healing compared with GTR alone. This clinical result confirms the histological findings (Part I article) that early initiation of OTM is feasible.
AIM:To investigate whether periodontitis stage and grade are associated with circulating active lipid mediators and whether baseline lipid species predict periodontitis progression. MATERIALS AND METHODS:The study included 473 Finnish participants from the Parogene cohort undergoing coronary angiography, with 12-year follow-up data available for 117 individuals. Periodontal status was assessed clinically and radiographically. Plasma ceramides (Cer) and phosphocholines (PC) were quantified by LC-MS/MS, and cardiovascular risk scores (CERT1 and CERT2) were calculated. RESULTS:Several Cer:Cer and Cer:PC ratios increased with periodontitis stage, grade and edentulousness, whereas most PC species decreased. Cer(d18:1/16:0)/PC(16:0/22:5), Cer(d18:1/18:0)/Cer(d18:1/24:0), Cer(d18:1/18:0)/PC(16:0/22:5) and Cer(d18:1/24:1)/PC(16:0/22:5) were associated with all periodontal measures. CERT2 was independently associated with both stage and grade. In cross-sectional analyses, periodontitis was associated with multiple lipid species both directly and indirectly through systemic inflammation. In longitudinal analyses, baseline lipid levels did not predict periodontitis progression. CONCLUSION:Periodontitis severity was found to be associated with systemic ceramide and phospholipid profiles, particularly Cer:PC ratios, whereas baseline lipid levels were not associated with subsequent disease progression. These findings suggest that systemic inflammation substantially mediates the relationship between periodontitis and circulating lipid species, linking periodontitis with broader disturbances in lipidomic homeostasis.
AIM:To characterise site-level gingival microcirculation in health and early inflammation without clinical attachment loss (CAL), and to evaluate its relationship with probing-derived clinical parameters and scan-derived gingival colour metrics. MATERIALS AND METHODS:In this cross-sectional observational study, gingival microcirculation was assessed at five maxillary anterior interdental papillae and matched keratinised gingival (KG) sites using a combined laser Doppler flowmetry and tissue spectrophotometry system (O2C), providing oxygen saturation (SO2), relative haemoglobin (Hb) and blood flow (Flow). Gingival papilla colour was extracted from intraoral scans and converted to CIE L*a*b* metrics. The primary analysis was restricted to sites without clinical attachment loss (CAL = 0 mm), with BOP used as a site-level indicator of gingival inflammation. Site comparisons, correlations and mixed-effects models were performed. RESULTS:Seventy-four young adults were included. Three-hundred and forty-six papilla sites and their matched KG sites were analysed. KG sites showed higher SO2, Hb and Flow than papilla sites. Papilla microcirculation showed substantial heterogeneity, with both between-participant and within-participant/site-level variance components. Clinical alignment was limited: papillary Hb was associated with probing depth (PD) and bleeding on probing (BOP), whereas Flow showed weaker associations and SO2 showed no significant association. In mixed-effects models, conventional clinical indices accounted for only a small proportion of the variance in papillary microcirculation. Among colour metrics, lightness (L*) showed the clearest clinical pattern, being inversely associated with BOP, PD and papillary Hb. CONCLUSIONS:In early gingival inflammation, papillary microcirculation is a measurable and heterogeneous site-level feature that is only partly captured by routine probing-derived parameters. Scan-derived gingival colour, particularly lightness, provides complementary information on local inflammatory status. Additional studies are needed to properly characterise microcirculation and tissue colour across the full health-disease spectrum.
AIM:To assess 10-year implant survival following surgical management of peri-implantitis using deproteinised bovine bone mineral with 10% collagen (DBBMC), enamel matrix derivative (EMD) and doxycycline powder. MATERIALS AND METHODS:The original population comprised 30 non-smoking, periodontally stable patients (mean age = 44.9 ± 11 years; 64% female; full-mouth plaque and bleeding score < 20%, no bleeding residual periodontal pockets ≥ 4 mm), each with a single peri-implantitis-affected implant (bleeding on probing, probing depth > 6 mm, ≥ 20% radiographic bone loss, implants in function ≥ 2 years). The surgical procedure involved implant surface decontamination with 24% EDTA followed by defect fill with DBBMC/EMD/doxycycline mixture. Patients underwent individualised supportive peri-implant therapy (SPIT) comprising regular clinical monitoring, professional cleaning and antimicrobial protocols for 10 years. RESULTS:Twenty-nine of the 30 implants survived (96.6% survival rate). Mean probing depth decreased from 8.90 ± 1.9 mm to 3.06 ± 0.98 mm; radiographic bone loss improved from 57% ± 16.5% to 13% ± 2.5%. During 10-year SPIT, 12 implants required adjunctive azithromycin. Fifty-eight percent achieved the successful treatment outcome criterion (SOTC: probing depth < 5 mm, no bone loss 10% from baseline, absence of bleeding on probing/suppuration and recession < 0.5 mm anterior/1.5 mm posterior implants). CONCLUSION:Surgical management of peri-implantitis combined with DBBMC/EMD/doxycycline and personalised SPIT achieved high long-term implant survival and stable clinical outcomes over 10 years.
AIM:To evaluate outcome measures in clinical studies on alveolar ridge augmentation (ARA) and map them to the Implant Dentistry Core Outcome Set and Measurement (ID-COSM) framework and the Food and Drug Administration (FDA) terminology. METHODS:A systematic search was carried out across four databases through June 2025. Randomised and non-randomised clinical trials, prospective clinical studies, cohort studies and pilot clinical studies evaluating ARA performed before or simultaneously with implant placement were included. Extracted outcomes were mapped to ID-COSM domains, subdomains and specific outcomes, and all were classified into FDA-style outcome types. Risk of bias (RoB) was assessed using Domain 4 of RoB 2.0/ROBINS-I, and associations between RoB and completeness of outcome reporting were analysed with Spearman's rank correlation and Kruskal-Wallis tests (α = 0.05). RESULTS:Four hundred and twenty-nine studies were included, predominantly randomised controlled trials (56.4%). Less than half of the studies fulfilled the mandatory ID-COSM domains (47.6%), and none reported all nine subdomains. For mandatory outcomes, surgical complications (52.7%) and implant placement feasibility (48.3%) were more frequently reported than bone dimensional changes (33.8%), and peri-implant bone stability was reported in only 11.0% of studies. For FDA categorisation, clinician-reported outcomes (86.3%) and biomarkers (87.7%) predominated, while patient-reported outcomes were reported in 31.9% of studies. Observer-reported or performance outcomes were completely absent. Lower risk of bias was associated with more complete reporting of outcomes across domains, subdomains and specific outcomes (p = 0.032, 0.017 and 0.009, respectively). CONCLUSION:Outcome reporting for ARA trials is highly heterogeneous and poorly aligned with the standardised minimum outcomes recommended by ID-COSM and FDA categorisation.
AIM:To evaluate the periodontal condition of individuals with different susceptibility to dental biofilm-induced gingivitis 25 years after their classification as high responders (HR) or low responders (LR) to plaque. METHODS:Forty-eight systemically and periodontally healthy young adults who participated in a 21-day experimental gingivitis trial in 2000-2001 and exhibited either markedly pronounced (HR, n = 24) or milder (LR, n = 24) gingival inflammation despite similar supragingival plaque exposure were invited to a follow-up visit, during which a periodontal diagnosis was established. RESULTS:Nine LR and eight HR individuals accepted to participate. Among the LR participants, six (67%) were diagnosed as periodontally healthy or with gingivitis, whereas 100% of HR participants were diagnosed with periodontitis (p = 0.009). Compared to LR, HR individuals presented higher bleeding on probing score (39.5% ± 13.8% vs. 15.0% ± 10.1%; p = 0.003) as well as a higher proportion of visibly inflamed sites (p < 0.001). Intergroup differences could not be explained by other variables, including full-mouth plaque score, oral hygiene habits or adherence to supportive care. CONCLUSIONS:This study, based on a very limited sample size and therefore hypothesis-generating rather than confirmatory, suggests that susceptibility to biofilm-induced gingivitis may help identify individuals at different risks of periodontitis.
AIM:This retrospective cohort study evaluate tooth loss and predictors during exceptionally long term supportive periodontal care (SPC), focusing on residual disease severity at SPC initiation. MATERIALS AND METHODS:Seventy patients maintained under SPC for > 30 years were analysed using negative binomial regression (log[SPC-duration] offset) and Cox proportional hazards models (clustered by patient). RESULTS:Over a mean SPC duration of 36.1 ± 3.0 [30-43] years, 63 patients lost 322 teeth (4.6 ± 4.2 per patient; 0.13 ± 0.12 per patient-year). Despite advanced baseline disease (stage III/IV: 97%), 35-year molar survival was 77% for FI 0 versus 51% for FI II-III. Tooth loss rate was significantly associated with PPD ≥ 6 mm (IRR 1.012; 95% CI 1.003-1.021; p = 0.009) and molar FI II-III (IRR 1.178; 95% CI 1.050-1.321; p = 0.005). A tooth-level Cox model confirmed elevated hazard for PPD ≥ 6 mm (HR 4.02; 95% CI 2.10-7.69) and FI II-III (HR 2.87; 95% CI 1.61-5.11). However, predictive accuracy was modest (PPV 36%-55%), indicating these markers reflect population-level risk rather than individual prognosis. CONCLUSION:Tooth loss remained low over > 30 years of SPC even for molars with advanced FI, while residual disease severity modulated this risk. Given strong survivorship bias (3.3% of eligible patients), generalisability beyond university-based specialist care is limited.
OBJECTIVE:To assess the peri-implant soft-tissue and hard-tissue response to monolithic zirconia (ZrO2) compared to porcelain-fused-to-metal implant crowns (PFMs). METHODS:This report constitutes a pre-specified secondary analysis of this RCT. Eighty-three patients rehabilitated with single-tooth implants in the molar region were originally randomly assigned to receive either a ZrO2 or a PFM restoration. At 6 months, clinical parameters (plaque control record, probing depth, bleeding on probing, width of keratinised mucosa and marginal bone level changes) were recorded at the implant site and the adjacent natural tooth. In addition, a peri-implant soft-tissue biopsy specimen was harvested between the implant site and the adjacent tooth. The number of inflammatory cells and fibroblasts/fibrocytes was evaluated within four regions of interest (oral epithelium, sulcular epithelium, junctional epithelium, connective tissue). Descriptive statistics were arrived at for all outcomes, and differences between prosthetic materials, sites and timepoints were analysed using linear mixed-effects models. RESULTS:The present exploratory secondary analysis included 67 patients (37 ZrO2; 30 PFM) with complete 6-month clinical, radiographic and histological data. Clinical parameters at both implant and adjacent tooth sites remained generally stable from baseline to 6 months, with limited marginal bone level changes and comparable outcomes between groups. Histologically, mixed-effects model analysis showed that the tissue region significantly affected both the inflammatory infiltrate and the fibroblast density (p < 0.001). The crown materials did not substantially influence the histological outcomes. The distribution of inflammatory infiltrate differed between tooth and implant sites, with the highest values in the sulcular epithelium around implants and in the junctional epithelium around teeth. Fibroblast density was highest in the junctional epithelium at both sites. CONCLUSION:Monolithic zirconia and PFM implant-supported single crowns resulted in comparable clinical and radiographic outcomes. The peri-implant soft-tissue response to the two restorative materials showed a greater effect of the tissue region, while the material itself had only negligible effect. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT02272491.
AIM:To compare 1-year clinical and radiographic outcomes of narrow- versus wide-diameter tissue-level implants for single molar replacement. MATERIALS AND METHODS:This two-arm randomised controlled trial enrolled 20 patients (23 implants) in one sextant. Participants received either 3.5-mm narrow-diameter implants (NDI, n = 12) or 5.0-mm wide-diameter implants (WDI, n = 11) using a tissue-level design with computer-guided surgery. The primary outcome was marginal bone loss (MBL) at 1 year assessed by periapical radiographs. Secondary outcomes included operation time, pre-allocation analysis of augmentation requirement, clinical peri-implant parameters, hard- and soft-tissue dimensions, mucosal recession and buccal soft-tissue contour and implant stability. Non-inferiority margin for MBL was 0.5 mm. RESULTS:All 23 implants achieved 100% survival. Mean MBL was 0.39 ± 0.29 mm for NDI and 0.48 ± 0.31 mm for WDI (upper 95% confidence interval [CI]: 0.176 mm), confirming non-inferiority of NDI. Operation time was shorter in this cohort for NDI (20.3 ± 9.3 min) than WDI (28.8 ± 15.3 min; one-sided p = 0.049). Peri-implant clinical parameters were comparable. CONCLUSIONS:NDI showed non-inferiority to WDI in MBL at 1 year while reducing operative time, supporting NDIs as a viable and efficacious alternative for anatomically restricted posterior sites. TRIAL REGISTRATION:Korean ClinicalResearch Information Service Number: KCT00094155.
AIM:To evaluate the diagnostic accuracy of self-reported periodontal symptoms compared to clinical periodontal status among older adults with and without dementia. MATERIALS AND METHODS:This cross-sectional study included adults ≥ 75 years of age who underwent public dental checkups in Japan. Self-reported gingival bleeding and tooth mobility were assessed as index tests against conceptually matched clinical reference standards: bleeding on probing (BOP) and clinically evaluated tooth mobility (Miller Grade ≥ II), respectively. Dementia status was obtained from health records. Sensitivity, specificity, positive and negative predictive values and area under the receiver operating characteristic curve (AUC) were calculated overall and stratified by dementia status. RESULTS:Of the 158,990 participants (3.9% with dementia), 61.2% were BOP-positive and 22.5% had Miller Grade ≥ II tooth mobility. Self-reported gingival bleeding showed poor diagnostic accuracy for BOP-positive status (AUC: 0.54; sensitivity: 0.24; specificity: 0.85). Self-reported tooth mobility showed higher but limited accuracy for Miller Grade ≥ II (AUC: 0.66; sensitivity: 0.43; specificity: 0.90), with lower accuracy in participants with dementia (AUC: 0.61) than in those without dementia (AUC: 0.67). CONCLUSIONS:Self-reported periodontal symptoms showed limited diagnostic accuracy in adults aged ≥ 75 years, with the awareness gap most pronounced for tooth mobility in individuals with dementia.
AIM:To assess the survival rates of dental implants placed in previously failed sites and identify systemic, site-specific and implant-related factors associated with implant loss. METHODS:This study included all dental implants (177,410 implants in 59,238 patients) placed between 2014 and 2023 within a nationwide dental network. Implant sequence (first, second, third or subsequent placement at the same site) was identified. Implant survival was assessed using Kaplan-Meier analysis and log-rank test. The Andersen-Gill extension of the Cox proportional hazards model was used in a multivariable analysis to identify independent predictors of failure. Separate Andersen-Gill Cox models were fitted for early and late failures. RESULTS:Overall implant survival was 97.5% after a mean follow-up of 4.61 ± 2.72 years. Survival declined progressively with repeated placement, from 97.6% (169,990/174,187) for first implants to 92.2% (2748/2980) for second implants and 88.5% (215/243) for third or subsequent implants (p < 0.001). The hazard of failure was 4.6 times higher for second implants (HR 4.60; 95% CI, 3.98-5.32; p < 0.001) and 5.7 times higher for third or later implants (HR 5.71; 95% CI, 3.68-8.87; p < 0.001), compared to the first implants. Independent predictors of failure included smoking, male sex, penicillin allergy, narrow diameter and maxillary placement. The association between implant sequence and failure differed by time after implantation. The hazard of early failure was 6.80 times higher for second implants (95% CI, 5.78-8.00; p < 0.001) and 9.27 times higher for third or later implants (95% CI, 5.57-15.45; p < 0.001), compared to the first implants. The hazard of late failure was 1.93 times higher for second implants (HR 1.93; 95% CI, 1.40-2.65; p < 0.001) and 2.63 times higher for third or later implants (HR 2.63; 95% CI, 1.24-5.58; p = 0.011), compared to the first implants. CONCLUSION:Reimplantation showed relatively favourable survival; however, failure risk increased with each successive implant placed at the same site, particularly early failures. Additionally, smoking, male sex, penicillin allergy, short and narrow implants and maxillary location were independent predictors of failure.
AIM:To investigate how functional tooth units (FTUs) and oral conditions are associated with dietary quality through multidimensional measures within a unified analytic framework. MATERIALS AND METHODS:Data were drawn from 6291 adults in the 2011-2014 National Health and Nutrition Examination Survey. Dentition status was assessed using FTUs and tooth count, and oral disease status was classified based on both untreated caries and periodontitis. Dietary outcomes derived from two 24-h dietary recalls included the Healthy Eating Index-2020 (HEI-2020), Dietary Approaches to Stop Hypertension index (DASH), alternate Mediterranean diet score (MED), Dietary Inflammation Index (DII), food groups and nutrient intakes. Distributional differences and associations between oral conditions and dietary outcomes were assessed using survey-weighted analyses. RESULTS:Participants with adequate FTUs had higher dietary quality than participants with impaired FTUs or edentulous participants. In fully adjusted models, each additional FTU was associated with higher HEI-2020 scores (β = 0.41, 95% CI: 0.29-0.54), lower DII scores (β = -0.06, 95% CI: -0.09 to -0.04) and more reported food items (β = 0.09, 95% CI: 0.04-0.14). Among dentate adults, untreated caries status was linked to less favourable dietary profiles after FTUs adjustment. In disease extent analyses, Decay% was associated with higher dietary quality indices than Decay + Filling% or periodontal parameters. After full adjustment, only Decay% remained significantly associated with added sugar intake in the analyses for foods and nutrients. In addition, oral conditions were significantly associated with overall food or nutrient variation, whereas sociodemographic factors accounted for a larger proportion of overall variation. CONCLUSIONS:Oral conditions show distinct associations with dietary quality. Impaired FTUs are linked to poorer dietary quality; coexisting caries and periodontitis are associated with the least favourable dietary quality. Oral conditions may help identify adults with less favourable dietary profiles, although sociodemographic factors explained greater overall dietary variation.
