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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dentistry, Oral Surgery and Oral Medicine".

Deadline for manuscript submissions: 25 August 2026 | Viewed by 8341

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Dr. Saverio Cosola

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Department of Stomatology, Tuscan Stomatologic Institute, Foundation for Dental Clinic, Research and Continuing Education, 55041 Camaiore, Italy
Interests: oral surgery; dental implants; manteinance of implant-prosthetic rehabilitation; bone biology; atrophic jaws; periodontal treatments; peri-implantitis; oral health; periomedicine
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Special Issue Information

Dear Colleagues,

This Special Issue explores the critical intersection between periodontal health and systemic diseases. Growing evidence underscores the impact of periodontal inflammation on conditions such as diabetes, cardiovascular disease, and adverse pregnancy outcomes. This issue aims to provide a comprehensive overview of these interactions, offering insights for clinicians and researchers alike.

We welcome submissions on the following:

Mechanisms linking periodontal pathogens to systemic inflammation;
Clinical evidence on periodontal treatment and systemic disease outcomes;
Preventive approaches for at-risk populations;
Interdisciplinary management strategies in implant-prosthetic rehabilitation.

Dr. Saverio Cosola
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

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Keywords

periodontitis
dental implants
systemic inflammation
diabetes and periodontal disease
cardiovascular implications
pregnancy and oral health
host immune responses
preventive dentistry
implant-prosthetic rehabilitation

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Published Papers (6 papers)

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Research

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14 pages, 1407 KB

Open AccessArticle

Long-Term Survival of Mandibular Incisors with Severe Periodontal Breakdown: Mean Follow-Up of 18 Years

by Ben De Backer, Hein De Backer, Georges Van Maele, Selena Toma and Véronique Christiaens

J. Clin. Med. 2026, 15(6), 2129; https://doi.org/10.3390/jcm15062129 - 11 Mar 2026

Viewed by 326

Abstract

Background: This retrospective study assessed long-term survival outcomes of severely periodontally compromised mandibular incisors (≥50% bone loss) following initial periodontal treatment and a structured recall protocol. Methods: Ninety-three patients with ≥50% bone loss in all mandibular incisors were treated in a private practice over a 32-year period by the same periodontist. Following initial treatment, patients were assigned 6- or 12-month recall intervals based on response and motivation. The baseline was set after subgingival debridement (visit 3). Last follow-up visit (LFV) in this study was defined as follows: the last control visit of the patients done by the periodontist. ‘Survival’ was divided into 3 groups: complete survival (CS), all incisors were still present, and partial survival (PS), one or two incisor(s) were lost. Total failure (TF) involved instances in which all incisors were lost. Effective survival was monitored when an extracted tooth was repositioned and stabilized with a splint, ensuring preservation of function. Only 9.7% of patients needed a mandibular incisal splint. For reasons of consistency the CPITN was used. Statistical analysis was performed in R. The significance level was set at α = 0.05. Event-free patients can be considered as uninformative censoring, all with the same probability of risk, as they all were still in follow-up at the time of informed consent approval. Results: A total of 93 patients were included in the study. The mean follow-up was 17.7 years. At the last visit, 79.6% of patients retained all incisors, with an effective survival rate of 89.2%. Regarding the survival probability over time, after 15 years, it is 91% (95% CI: 0.86–0.98), and after 20 years, it is 78% (95% CI: 0.69–0.90). The effective survival probability over time after 15 years was 95% (95% CI: 0.91–1.0), and after 20 years, it was 89% (95% CI: 0.81–0.98). Compliance significantly influenced survival (p = 0.007), whereas the number of occluding units did not (p = 0.226). The total amount of teeth lost during the entire follow-up period showed a statistically significant difference compared to survival (p < 0.001). The general periodontal health of the patient population presented a shift from CPITN 3 to the 0–2 group. Conclusions: Severely compromised mandibular incisors demonstrate high long-term survival rates with appropriate therapy. After 20 years the survival probability was 78%, and the effective survival probability, 89%, underscoring the critical role of lifelong periodontal care. Mandibular incisor preservation over long-term follow-up is highly achievable. Full article

(This article belongs to the Special Issue Periodontal Diseases and Systemic Health: Pathogenesis, Prevention and Management)

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15 pages, 493 KB

Open AccessArticle

Genetic Polymorphism of IL-1A, IL-1B and TNFA Predicting the Presence of Periodontopathogenic Bacteria

by Nina Kalajzic, Ajka Pribisalic, Marina Adriana Jezina Buselic, Samra Prentic Bakic, Dunja Petricic, Ferdinand Josip Buselic, Davorka Sutlovic and Sendi Kuret

J. Clin. Med. 2026, 15(4), 1646; https://doi.org/10.3390/jcm15041646 - 22 Feb 2026

Viewed by 445

Abstract

Background/Objectives: Periodontitis is a chronic inflammatory disease characterized by complex interactions between periodontal pathogens and the host immune response. Pro-inflammatory cytokines, particularly interleukins, may influence bacterial colonization and disease expression, but their association with specific periodontal pathogens remains unclear. This study investigated the associations between single-nucleotide polymorphisms in IL-1A, IL-1B, and TNFA and the presence of key periodontopathogenic bacteria in patients from Croatia. Methods: A cross-sectional study included 63 participants. Genotypes were determined, and subgingival plaque samples were analyzed for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola using real-time PCR. Multivariable logistic regression models assessed associations between cytokine gene polymorphisms and periodontopathogenic bacteria presence, adjusting for age, gender, smoking status, and the presence of systemic diseases. Results: Among participants (median age 57.0 years, IQR 43.5–67.0; 58.7% female), P. intermedia (87.3%), T. forsythia (85.7%), and T. denticola (69.8%) were the most prevalent pathogens. The IL-1A CC genotype significantly increased the odds of P. gingivalis (OR = 5.54; p = 0.009) and T. denticola (OR = 3.77; p = 0.041) presence. The IL-1B CC genotype was independently associated with T. forsythia (OR = 8.48; p = 0.026). No significant associations were observed for TNFA polymorphism. Model performance ranged from moderate to good (AUC up to 0.89). Conclusions: Genetic variants in IL-1A and IL-1B may influence periodontal bacterial colonization, while demographic and lifestyle factors showed limited impact. Further studies in larger cohorts are warranted. Full article

(This article belongs to the Special Issue Periodontal Diseases and Systemic Health: Pathogenesis, Prevention and Management)

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19 pages, 627 KB

Open AccessArticle

Cross-Sectional Comparative Assessment of Periodontal Status in Diabetic and Non-Diabetic Individuals Within a Romanian Cohort

by Iulia Alexa, Ramona Dumitrescu, Vlad Tiberiu Alexa, Simona Popescu, Vanessa Bolchis, Lucian Floare, Octavia Balean, Atena Galuscan and Daniela Jumanca

J. Clin. Med. 2025, 14(22), 8199; https://doi.org/10.3390/jcm14228199 - 19 Nov 2025

Cited by 1 | Viewed by 860

Abstract

Background/Objectives: Periodontitis and diabetes mellitus are known to exert a bidirectional pathogenic influence characterized by metabolic dysregulation, exaggerated inflammatory response, and accelerated periodontal breakdown. Despite the increasing prevalence of both conditions in Eastern Europe, comparative clinical data from Romanian populations remain limited. This study aimed to assess differences in periodontal status, systemic comorbidities, smoking exposure, and local periodontal risk factors between diabetic and non-diabetic individuals in a Romanian cohort. Methods: This cross-sectional study included 345 adults (152 with diabetes; 193 non-diabetic individuals) all diagnosed with periodontitis. Although participants were recruited to achieve comparable distributions of sex and smoking status, individuals with diabetes were significantly older than controls. Full-mouth periodontal examination was performed following the 2018 EFP/AAP classification criteria. Clinical parameters included probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI), and bleeding on probing (BOP). Periodontal staging and grading were determined, and local risk factors were recorded using a multiple-response approach. Systemic comorbidities and smoking exposure were also evaluated. Statistical analyses involved t-tests, chi-squared tests, and Spearman correlations; significance was set at p < 0.05. Results: Diabetic patients exhibited significantly higher mean PPD (4.33 ± 1.22 mm vs. 3.70 ± 0.86 mm; mean difference 0.63 mm, 95% CI: 0.45–0.81), greater CAL (mean difference 0.19 mm, 95% CI: 0.01–0.37), and elevated PI and BOP (PI mean difference 18.97%, 95% CI: 12.44–25.50; BOP mean difference 17.23%, 95% CI: 10.86–23.60). Advanced stages (III–IV) and Grade C periodontitis were more prevalent among diabetic individuals. Diabetic participants also presented a higher burden of local plaque-retentive factors and systemic comorbidities (notably hypertension and cardiovascular disease), as well as higher smoking intensity. Conclusions: Diabetes mellitus is associated with markedly poorer periodontal status, greater systemic disease burden, and increased prevalence of plaque-retentive local factors. These findings reinforce the bidirectional relationship between diabetes and periodontitis and support the integration of periodontal assessment into metabolic disease management protocols. Full article

(This article belongs to the Special Issue Periodontal Diseases and Systemic Health: Pathogenesis, Prevention and Management)

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19 pages, 2197 KB

Open AccessArticle

Association Between Cardiovascular Disease and Complete Edentulism in U.S. Adults

by Saud Alyahya, Basel Hamoud, Ali Alqattan, Masoud Almasoud, Yousef Almehjan, Rashed Alajmi, Hesham Alhazmi and Hend Alqaderi

J. Clin. Med. 2025, 14(17), 6035; https://doi.org/10.3390/jcm14176035 - 26 Aug 2025

Cited by 2 | Viewed by 1720

Abstract

(1) Background: Cardiovascular disease (CVD) and edentulism are major public health challenges with shared risk factors and overlapping inflammatory pathways. This study investigates the association between complete tooth loss and CVD. (2) Methods: Data were analyzed from the 2015–2018 National Health and Nutrition Examination Survey (NHANES) dataset using Poisson regression analysis to examine the relationship between CVD and complete edentulism, adjusting for age, sex, education, family income-to-poverty ratio, race/ethnicity, diabetes status, and BMI. Of the 11,287 participants, 1763 individuals (15.62%) were completely edentulous, and 9524 (84.38%) retained some or all of their dentition. (3) Results: Individuals with cardiovascular conditions, including myocardial infarction (PR = 1.55; 95% CI: 1.23–1.98), coronary heart disease (PR = 1.44; 95% CI: 1.13–1.85), congestive heart failure (PR = 1.58; 95% CI: 1.22–2.07), and stroke (PR = 1.46; 95% CI: 1.13–1.90), demonstrated a higher prevalence of complete edentulism compared to those without these conditions, after adjusting for key demographic and health-related confounders (p < 0.01). (4) Conclusions: These findings suggest a statistical association between CVD and complete edentulism in U.S. adults. However, due to the cross-sectional nature of this study, causal relationships cannot be inferred, and further longitudinal studies are needed to understand the bidirectional mechanisms between CVD and complete edentulism. Full article

(This article belongs to the Special Issue Periodontal Diseases and Systemic Health: Pathogenesis, Prevention and Management)

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Review

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22 pages, 8032 KB

Open AccessEditor’s ChoiceReview

Advanced Diagnostic Technologies and Molecular Biomarkers in Periodontitis: Systemic Health Implications and Translational Perspectives

by Sebastian Biesiadecki, Monika Janeczko, Joanna Kozak, Magdalena Homaj-Siudak, Lukasz Szarpak and Mansur Rahnama-Hezavah

J. Clin. Med. 2026, 15(3), 1142; https://doi.org/10.3390/jcm15031142 - 2 Feb 2026

Cited by 1 | Viewed by 772

Abstract

Background/Objectives: Periodontitis is a chronic inflammatory disease with marked inter-individual heterogeneity and well-established links to cardiometabolic and other systemic conditions. Conventional clinical diagnostics remain indispensable. However, they provide limited real-time insight into molecular activity and host-response biology. This review aimed to synthesize recent advances in point-of-care diagnostics and emerging molecular biomarkers relevant to periodontal disease and its systemic associations. Methods: We performed a state-of-the-art narrative review of literature published between 2018 and 2026. The focus was on point-of-care biosensing technologies and molecular biomarkers assessed in oral and related biological matrices. These included saliva, gingival crevicular fluid, blood, and dental plaque. Evidence was prioritized based on analytical performance, clinical validity, and translational readiness. Results: Substantial progress has been made in multiplex optical and electrochemical point-of-care platforms. These include microfluidic systems and early intraoral wearable sensors. Such technologies enable quantification of host-response proteins, including MMP-8, cytokines, and chemokines. In parallel, omics-derived biomarkers are emerging as clinically informative adjuncts for diagnosis and monitoring. MicroRNAs, cell-free DNA, extracellular vesicle–derived signals, proteomic profiles, and microbiome classifiers demonstrate promising discrimination. They also provide mechanistic links to systemic inflammation. Clinical translation remains limited by study heterogeneity, spectrum bias, and insufficient external validation. Conclusions: Near-term clinical value lies in adjunctive risk stratification and longitudinal disease monitoring. Replacement of conventional periodontal examination is not currently justified. Meaningful clinical and public-health impact will require standardized disease definitions. Harmonized sampling and reporting protocols are essential. Multicenter validation across comorbidity strata is needed. Regulatory-grade evidence must be generated for in vitro diagnostics and artificial intelligence software classified as medical devices. Full article

(This article belongs to the Special Issue Periodontal Diseases and Systemic Health: Pathogenesis, Prevention and Management)

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Other

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25 pages, 1137 KB

Open AccessSystematic Review

Neurosensory Disturbances Following Inferior Alveolar Nerve Relocation and Implant Placement: A Systematic Review and Meta-Analysis

by Raffaele Vinci, Saverio Cosola, Korath Varkey M, Sowndarya Gunasekaran, Jaibin George and Ugo Covani

J. Clin. Med. 2025, 14(16), 5741; https://doi.org/10.3390/jcm14165741 - 14 Aug 2025

Cited by 6 | Viewed by 3427

Abstract

Background: Rehabilitation of atrophic posterior mandibles using dental implants is often complicated by anatomical limitations, particularly the proximity of the inferior alveolar nerve (IAN). Techniques such as IAN lateralization and transposition enable implant placement but are associated with neurosensory disturbances (NSDs). This systematic review and meta-analysis aimed to assess the incidence, duration, and predictors of NSDs following IAN repositioning for implant placement and to evaluate the effectiveness of adjunctive methods like piezo-surgery and platelet-rich fibrin (PRF) in minimizing complications. Methods: Following PRISMA 2020 guidelines, a comprehensive search of electronic databases and gray literature identified 20 studies, including randomized controlled trials, prospective cohorts, and retrospective analyses published between 2009 and 2024. Outcomes analyzed included incidence of NSDs, recovery rates, implant stability quotient (ISQ), marginal bone loss, and implant success rates. Meta-analysis was performed using RevMan 5.3 software, with heterogeneity and publication bias assessed using standard Cochrane tools. Results: Transient NSDs occurred in 15–40% of cases, with higher rates observed in transposition techniques. Most patients experienced recovery within 6 months. Piezoelectric surgery significantly reduced the incidence and duration of NSDs compared to rotary instruments. Meta-analysis revealed no statistically significant differences between lateralization and transposition techniques in ISQ, marginal bone loss, success rate, or NSDs at 3 months (p > 0.05). PRF was associated with accelerated nerve recovery. IAN repositioning is effective for implant placement in atrophic mandibles with a risk of transient NSDs. Conclusions: Lateralization combined with piezo-surgery and PRF shows favorable outcomes in minimizing nerve injury and optimizing implant success. The PROSPERO registration code is as follows: CRD420251086835. Full article

(This article belongs to the Special Issue Periodontal Diseases and Systemic Health: Pathogenesis, Prevention and Management)

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