Maurizio Tonetti

• DMD, PhD, MMSc
• Research Director at European Research Group on Periodontology

The European Federation of Periodontology (EFP), founded in 1991, is a non‐profit organization comprising 43 national periodontal societies worldwide, representing over 18 000 professionals. Its mission is to promote periodontology and oral health globally. The EFP's strategic objectives include advancing the practice and development of periodontol...

Aim To evaluate the diagnostic accuracy of an active matrix metalloproteinase‐8 (aMMP‐8) point‐of‐care oral rinse test (POC‐ORT) for predicting periodontitis in treatment‐naïve subjects in two independent studies and update a recent meta‐analysis. Methods The aMMP‐8 POC‐ORT index test was performed in a representative population in Hong Kong, Chin...

Aim: Masticatory dysfunction due to tooth loss is a potentially modifiable risk for mortality, but the pathway behind that remains to be investigated. This prospective study aimed to examine the role of diet and ageing in the associations between chewing capacity and long-term mortality. Methods: Data were obtained from participants (aged ≥ 20) in...

Precise surgical positioning according to a digital plan is important for aesthetic and biologically stable dental implant restorations. This randomized controlled trial compared implant placement assisted by robotic surgery (RS), dynamic navigation (DN), or 3-dimensional printed static guide (SG). An overall 45 patients with a missing tooth in the...

Background and Aim Clinical practice guidelines suggest access flap surgery for managing deep residual pockets after steps 1 and 2 of periodontal therapy. Papilla‐preservation flap surgery (PPFS) is the least invasive approach to access and instrument biofilm‐contaminated root surfaces. Endoscopic‐assisted subgingival debridement (EASD) may enhance...

Aim To examine the independent and joint associations of oral microbiome diversity and diet quality with risks of all‐cause and cause‐specific mortality. Materials and Methods We included 7,055 eligible adults from the U.S. National Health and Nutrition Examination Survey (NHANES). Oral microbiome diversity was measured with α‐diversity, including...

Aim Depression is prevalent among older adults. Although the number of missing teeth is considered to be associated with depression, the relationship between masticatory function, which is usually indicated by functional tooth units (FTUs), and depression in older adults remains unclear. Materials and Methods This study used data from the National...

Aim Impairment of masticatory function in elderly patients with terminal dentition due to stage IV periodontitis (TDS4P) may lead to lower nutritional intake. The study aimed to report the dietary intake and nutrition status of elderly patients with TDS4P and compare them with those of the elderly Chinese population and the Chinese Dietary Referenc...

Objective To determine the accuracy of salivary active matrix metalloproteinase (aMMP)‐8 point‐of‐care test (POCT) for detecting periodontitis in adults, through meta‐analysis. Materials and Methods Diagnostic studies evaluating the accuracy of salivary/oral rinse aMMP‐8 POCT for detecting periodontitis in adults, when compared with clinical exami...

Abstract Background The second European Consensus Workshop on Education in Periodontology was commissioned, as a result of the changes in the discipline and the advances in educational methods/technology, to update the 2009 Consensus report of the first European Federation of Periodontology (EFP) Workshop on the same topic that was jointly authore...

Aim Treatment of periodontitis, a chronic inflammatory disease driven by biofilm dysbiosis, remains challenging due to patients' poor performance and adherence to the necessary oral hygiene procedures. Novel, artificial intelligence‐enabled multimodal‐sensing toothbrushes (AI‐MST) can guide patients' oral hygiene practices in real‐time and transmit...

Objectives To systematically analyze the accuracy of robotic surgery for dental implant placement. Materials and Methods PubMed, Embase, and Cochrane CENTRAL were searched on October 25, 2023. Model studies or clinical studies reporting the accuracy of robotic surgery for dental implant placement among patients with missing or hopeless teeth were...

Aim To propose a framework for consistently applying the 2018 periodontal status classification scheme to epidemiological surveys (Application of the 2018 periodontal status Classification to Epidemiological Survey data, ACES). Proposed Framework We specified data requirements and workflows for either completed or planned epidemiological surveys,...

Aim Emerging evidence points to a two‐way relationship between periodontitis and dietary choices and, thus, nutrition. This study aimed to assess the potential cause–effect relationship between the periodontitis stage, loss of functional tooth units (FTUs), masticatory function, and intake of different food groups using path analysis. Materials an...

Aim This study aimed to characterize the periodontal breakdown during supportive periodontal care (SPC) and to quantify the corresponding cost‐effectiveness of periodontal therapy. Materials and Methods Data were obtained from charts of patients who received active periodontal therapy (APT) with a minimum follow‐up of ≥10 years. Analysis was done...

Aim: To compare the implant accuracy, safety and morbidity between robot-assisted and freehand dental implant placement. Materials and methods: Subjects requiring single-site dental implant placement were recruited. Patients were randomly allocated to freehand implant placement and robot-assisted implant placement. Differences in positional accu...

Accurate periodontal disease classification from panoramic X-ray images is of great significance for efficient clinical diagnosis and treatment. It has been a challenging task due to the subtle evidence in radiography. Recent methods attempt to estimate bone loss on these images to classify periodontal diseases, relying on the radiographic manual a...

Objectives The aim of this clinical study was to compare the accuracy of intraoral scan system (IOS) with prefabricated aids and stereophotogrammetry (SPG) compared with open tray implant impression (OI) for complete-arch implant-supported fixed dental prostheses (CIFDP). Materials and methods Patients needing CIFDP were enrolled in this study. OI...

Aims: Denture use may potentially increase the risk of cardiometabolic diseases (CMDs), but the casual relevance and strength of the associations are currently unknown. Methods: 495 938 participants from the UK Biobank were included in the observational analyses. Linkage disequilibrium score (LDSC) regression and Mendelian randomization analyses...

Aim: To develop a multiclass non-clinical screening tool for periodontal disease and assess its accuracy for differentiating periodontal health, gingivitis and different stages of periodontitis. Materials and methods: A cross-sectional diagnostic study on a convenience sample of 408 consecutive subjects was conducted by applying three non-clinic...

Consensus on a valid and comprehensive set of outcomes to capture the full benefits and harms of implant dentistry interventions is key for progressing toward better clinical guidelines and policy. In this field, research remains fragmented and uses too many different outcomes. Studies are unable to cover the full breadth necessary to properly eval...

Background: The shape of implant restorations is critical for function and aesthetics. It may also be important in peri-implant tissue health preservation. This study aimed to associate the restorative contour of a single crown with marginal dental plaque accumulation, tissue inflammation and probing depths. Methods: Subjects with a single screw...

Background: The purpose of this study was to evaluate the reliability and accuracy in the assignment of the case definitions of peri-implant health and diseases according to the 2018 Classification of Periodontal and Peri-implant Diseases and Conditions. Methods: Ten undergraduate students, 10 general dentists, and 10 experts in implant dentistry p...

Background: The recently published Clinical Practice Guidelines (CPGs) for the treatment of stages I-IV periodontitis provided evidence-based recommendations for treating periodontitis patients, defined according to the 2018 classification. Peri-implant diseases were also re-defined in the 2018 classification. It is well established that both peri...

Objectives: Multiple generations of medical robots have revolutionized surgery. Their application to dental implants is still in its infancy. Co-operating robots (cobots) have great potential to improve the accuracy of implant placement, overcoming the limitations of static and dynamic navigation. This study reports the accuracy of robot-assisted...

Objectives: This study investigates the correlation between soft tissue volumetric changes and clinical periodontal parameters for patients suffering from Stage III periodontitis after non-surgical periodontal treatment (NSPT) via intraoral scanning. Methodology: The following study is a case series pilot study involving twenty-eight Stage III P...

Aim: Lack of consistently reported outcomes limits progress in evidence-based implant dentistry and quality of care. The objective of this initiative was to develop a core outcome set (COS) and measurements for implant dentistry clinical trials (ID-COSM). Materials and methods: This Core Outcome Measures in Effectiveness Trials (COMET)-registere...

Aims: The aims of this project were to establish the outcomes for dental implant research that are important to people with lived experience (PWLE) and to achieve consensus with those developed by dental professionals (DPs) for a core outcome set (COS). This paper reports the process, outcomes and experiences of involving PWLE in developing a COS...

Aim: To obtain input from multiple stakeholders and generate agreement on essential outcomes in implant dentistry using the Delphi methodology and incorporate them into an international consensus defining a core outcome set. Materials and methods: Candidate outcomes in implant dentistry were generated from scientific evidence through five commis...

Aims: The aims of this project were to establish the outcomes for dental implant research that are important to people with lived experience (PWLE) and to achieve consensus with those developed by dental professionals (DPs) for a core outcome set (COS). This paper reports the process, outcomes and experiences of involving PWLE in developing a COS...

Aim: To obtain input from multiple stakeholders and generate agreement on essential outcomes in implant dentistry using the Delphi methodology and incorporate them into an international consensus defining a core outcome set. Materials and methods: Candidate outcomes in implant dentistry were generated from scientific evidence through five commis...

Aim: Lack of consistently reported outcomes limits progress in evidence-based implant dentistry and quality of care. The objective of this initiative was to develop a core outcome set (COS) and measurements for implant dentistry clinical trials (ID-COSM). Materials and methods: This Core Outcome Measures in Effectiveness Trials (COMET)-registere...

Objectives: The objectives were to clarify if intraoral ultrasonography (USG) is: (1) more accurate than conventional periodontal examinations in detection of furcation involvement, and (2) comparable to conventional periodontal examinations in accurate horizontal classification of furcation involvement in comparison to cone beam computed tomograp...

Consensus on a valid and comprehensive set of outcomes to capture the full benefits and harms of implant dentistry interventions is key for progress towards better clinical guidelines and policy. In this field, outcome research remains fragmented and uses too many different outcomes. Still they are unable to cover the full breadth necessary to prop...

Background: The purpose of the present study was to assess root coverage outcomes ten years after Connective Tissue Graft (CTG) plus Coronally Advanced Flap (CAF) or CAF alone at single RT2 maxillary gingival recession MATERIAL AND METHODS: Twenty-one of the original 29 patients, 11 treated with CAF + CTG and 10 with CAF, were available for the 10...

Aim To evaluate the relative efficacy and confidence in the precision of the results of different surgical interventions for immediate implant placement in the anterior area. Materials and Methods Electronic searches were performed in PubMed, Embase, and Cochrane CENTRAL. Randomized controlled trials comparing different surgical techniques in ante...

Objectives This systematic review and meta-analysis aim to evaluate the effect modifiers which may influence the periodontal healing of the adjacent second molar after lower third molar surgery. Materials and methods Prospective studies including patients with third molars requiring removal, with at least 6 months follow-up were considered. Outcom...

Objectives: Simplification and standardization of interventions are critical challenges to improving performance in implant dentistry. This study aimed to systematically identify and schematically present the evidence base of the implant dentistry surgical interventions for the anterior maxilla as a basis for further development and standardizatio...

Aim: To investigate the association of the number of natural teeth with overall dietary diversity and nutritional status in a nationally representative study among older adults in China. Materials and methods: A cross-sectional analysis was conducted among community-dwelling adults aged 65 years or older from the Chinese Longitudinal Healthy Lon...

Objectives: The purpose of this study was to assess the diagnostic accuracy and the inter-rater agreement among general dentists when staging and grading periodontitis cases with the aid of a software application (SA) developed by the Italian Society of Periodontology and Implantology. Materials and methods: Ten general dentists were asked to in...

L-PRF is an autologous blood-derived biomaterial (ABDB) capable of releasing biologically active agents to promote healing. Little is known about its release profile of growth factors (GFs), cytokines, and MMPs. This study reported the in vitro and ex vivo release kinetics of GFs, cytokines, and MMPs from L-PRF at 6, 24, 72, and 168 h. The in vitro...

Background Loss of masticatory function consequent to tooth loss has been associated with changes in food choices and insufficient nutritional intake. To date, interventions based on dental prostheses alone did not significantly improve nutrient intake. Pilot studies have shown positive impacts of interventions combining implant-supported fixed den...

Aims: Leucocyte- and platelet-rich fibrin (L-PRF) has been tested for enhancing alveolar ridge preservation (ARP), but little is known about the local release profile of growth factors (GF) and the clinical equipoise related to its efficacy remains. This study compared the patterns of GF release, early soft tissue healing and alveolar ridge resorp...

Objectives: This randomized controlled clinical trial was designed to compare the accuracy of machine-vision (MV) based dynamic navigation (DN) assisted immediate implant placement with the conventional free hand technique. Material and methods: 24 subjects requiring immediate implant placement in maxillary anterior teeth were randomly assigned...

Background: The recently published clinical practice guideline (CPG) for the treatment of periodontitis in stages I-III provided evidence-based recommendations for the treatment of periodontitis patients, defined according to the 2018 classification. Stage IV periodontitis shares the severity and complexity characteristics of stage III periodontit...

Background and objectives: Assessment of biomarkers, specifically active matrix metalloproteinase-8 (aMMP-8), in saliva/oral rinses is a promising diagnostic approach for periodontal health and disease. Different oral fluids have specific advantages and limitations. This study investigates the effect of sampling different fluids on the accuracy of...

Background: Modified Minimally Invasive Surgical Technique (M-MIST) optimizes wound stability in the treatment of intrabony defects. Short-term observations show similar results with flap alone or adjunctive regenerative materials. This study aims to compare stability of the long-term outcomes, complication free survival and costs of 3 treatment....

Background: After diagnosis of periodontitis is made, detection of stage IV cases is critical for appropriate management that may call for interdisciplinary care. This study aims to identify and assess the accuracy of a simple screening approach for practice and surveillance of stage IV periodontitis. Methods: Masticatory function assessments by...

Introduction Considerable evidence has linked periodontitis (PD) to hypertension (HTN), but the nature behind this connection is unclear. Dysbiosis of oral microbiota leading to PD is known to aggravate different systematic diseases, but the alteration of oral microbiota in HTN and their impacts on blood pressure (BP) remains to be discovered. Obj...

Antecedentes: La clasificación de la periodontitis recientemente introducida en el World Workshop de 2017, que incorpora estadios y grados de la enfermedad, tiene por objeto vincular la clasificación de la enfermedad con los enfoques preventivos y terapéuticos, ya que no solo describe su gravedad y el alcance, sino también el grado de complejidad y...

Aims To describe periodontal and functional characteristics of subjects diagnosed with different stages of periodontitis and to associate measures of masticatory function and quality of life with periodontitis stage. Methods This was a cross-sectional study on a convenience sample of 214 subjects with periodontitis seeking oral care in a hospital...

Background Analysis of distribution of P-values of continuous differences between test and controls after randomization provides evidence of unintentional error, non-random sampling, or data fabrication in RCTs. This study assessed evidence of highly unusual distributions of baseline characteristics of subjects enrolled in clinical trials in implan...

Aims To assess the accuracy of self-reported gingival bleeding on brushing (GBoB) for differentiating between periodontal health and disease and explore the optimal hemoglobin concentration that enables visual detection of GBoB. Methods Self-assessment of GBoB was conducted in supervised sessions for 408 consecutive adults. The hemoglobin levels i...

Complement plays a key role in immunosurveillance and homeostasis. When dysregulated or overactivated, complement can become a pathological effector, as seen in several inflammatory disorders, including periodontal disease. Recently, clinical correlative studies and preclinical mechanistic investigations have collectively demonstrated that compleme...

Complement plays a key role in immunosurveillance and homeostasis. When dysregulated or overactivated, complement can become a pathological effector, as seen in several inflammatory disorders, including periodontal disease. Recently, clinical correlative studies and preclinical mechanistic investigations have collectively demonstrated that compleme...

Background: A new periodontitis classification was recently introduced involving multidimensional staging and grading. The Study's aim was to assess if individuals well-trained in periodontics consistently used the new classification for patients with severe periodontitis. The secondary goal was to identify "gray zones" related to classifications....

Objectives evaluate in a case series the clinical applicability of a regenerative approach for treatment of peri-implant lesions based on papilla preservation flaps (PPF) and minimally invasive surgery (MIST). Material and Methods 21 deep peri-implant defects in 21 patients were surgically accessed applying PPF and MIST. The exposed implant surfac...

Objectives High prevalence of disto-lingual roots (DLR) at the mandibular molar in Chinese can complicate the management of periodontitis. This study assessed the prevalence and morphological features of mandibular first molar DLR and furcation entrances in a Hong Kong population by analysis of cone beam computed tomography (CBCT).Materials and met...

Aims To assess the diagnostic utility of an oral rinse active matrix metalloproteinase‐8 (aMMP‐8) point‐of‐care test (POCT) for differentiating periodontal health, gingivitis, as well as different stages and grades of periodontitis. Methods The aMMP‐8 index test was undertaken in 408 consecutive adults, followed by a full‐mouth periodontal examina...

Aim To clinically validate a self‐reported questionnaire for periodontal disease and assess its accuracy for differentiating periodontal health and different stages of periodontitis. Methods A Chinese (Cantonese) version of a self‐reported questionnaire was prepared by translating and validating the original English questions proposed by the Cente...

Aim To report the 36‐month follow‐up of a trial comparing the adjunct of a xenogenic collagen matrix (CMX) or connective tissue graft (CTG) to coronally advanced flaps (CAF) for coverage of multiple adjacent recessions. Material and Methods 125 subjects (61 CMX) with 307 recessions in 8 centres from the parent trial were followed‐up for 36‐months....

Background and aims: Periodontitis is an inflammatory-infectious disease. Identifying markers of systemic exposure of periodontitis might be of interest to study its interaction with other conditions. Soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) is upregulated during bacterial infections. Our aim was therefore to investigate w...

Aim To compare the 3‐year clinical, radiographic and economic outcomes of short‐6‐mm implants and longer implants combined with osteotome sinus floor elevation (OSFE) in the posterior maxilla. Material and Methods This study enrolled 225 patients (225 implants with diameter of 4.1mm and 4.8mm) with a posterior maxillary residual bone height （RBH）...

Aim: The objective of this study was to evaluate consistency and accuracy of the periodontitis staging and grading classification system. Methods: Thirty participants (10 periodontal experts, 10 general dentists and 10 undergraduate students) and a gold-standard examiner were asked to classify 25 fully documented periodontitis cases twice. Fleis...

Background Systematic reviews have established the short‐term improvements of periodontal regenerative/reconstructive procedures compared to conventional surgical treatment in intrabony defects. However, a hierarchy of periodontal regenerative/reconstructive procedures regarding the medium‐ to long‐term results of treatment does not exist. Aim To...

Background It is thought that infrabony defect morphology affects the outcome of periodontal regenerative surgery. However, this has not been systematically investigated. Aims To investigate how well defect morphology is described in papers reporting regenerative therapy of periodontal infrabony defects and to investigate its effect on clinical an...

Objective: The aim of the present study was to report 10-year results of osteotome sinus floor elevation (OSFE) without grafting severely atrophic maxilla (residual bone height ≤4mm). Materials and methods: Patients undergoing OSFE without grafting and implant placement were included for 10-year examinations. Implant survival, complications free...

Background Bleeding on brushing (BoB) is an important sign of gingival inflammation. Recently, the use of intelligent toothbrushes and oral health Apps has shown potential to improve oral and periodontal health. In the context of the introduction of an internet of things network of intelligent power driven toothbrushes in a supportive periodontal c...

Background Aim of this systematic review (SR) of randomized controlled trials (RCTs) was to evaluate effect of different flap designs and graft materials for root coverage, in term of esthetics, patient satisfaction and self‐reported morbidity (post‐operative pain/discomfort). Material and methods A comprehensive literature search was performed. A...

Background The aim of this study was to retrospectively assess bone volumes, healed ridge topography and possibility to plan prosthetically guided implants (PGI) at least 6 months after extraction or exfoliation of first molars as a consequence of terminal periodontitis (EEFMP). Material and Methods 45 subjects with Stage III‐IV periodontitis prov...

Background The recently introduced 2017 World Workshop classification of periodontitis, incorporating stages and grades of disease, aims to link disease classification with approaches to prevention and treatment, as it not only describes disease severity and extent, but also the degree of complexity and an individual`s risk. There is, therefore, a...

Background Periodontitis significantly increases the risk of diabetic complications. This clinical trial investigated the effects of periodontal therapy on cardiac function in patients with type 2 diabetes mellitus (T2DM) and periodontitis. Materials and methods Fifty‐eight subjects with T2DM and periodontitis were randomly allocated to Treatment...

Background Periodontal regeneration can change tooth prognosis and represents an alternative to extraction in teeth compromised by severe intrabony defects. The aim of this study was to compare periodontal regeneration (PR) with tooth extraction and replacement (TER) in a population with attachment loss to or beyond the apex of the root in terms of...

Objective This systematic review evaluated the impacts of non-surgical periodontal therapy (NSPT) in patients with chronic kidney disease (CKD) and periodontitis in order to explore causality and assess the potential benefits of co-management. Methods This systematic review and meta-analyses were conducted by searching MEDLINE, EMBASE, PubMed, Coc...

This editorial provides clarifications on the application of the Stage and Grade classification of periodontitis. In particular it describes: i) how to apply the extent criterion to the defined Stage of the disease; and ii) how to calculate tooth loss due to periodontitis in Stage III and IV cases presenting with evidently hopeless (irrational to t...

This editorial provides clarifications on the application of the Stage and Grade classification of periodontitis. In particular it describes: i) how to apply the extent criterion to the defined Stage of the disease; and ii) how to calculate tooth loss due to periodontitis in Stage III and IV cases presenting with evidently hopeless (irrational to t...

Purpose: No information is available on the perception of the quality of care in patients treated for periodontitis. The purpose of this article was to assess how periodontitis-affected patients perceive the quality of periodontal treatment (PT) and to measure the factors which may influence it. Materials and methods: 306 subjects who completed...

Aim: The aim of this study was to compare surgical treatment of periodontal intra-bony defects (IBD) with or without the adjunct of enamel matrix derivative (EMD) in terms of acute-phase responses in healthy patients. Methods: Thirty-eight periodontitis-affected subjects, one IDB each, were randomized to minimally invasive periodontal surgery (M...

Background: In Europe cardiovascular disease (CVD) is responsible for 3.9 million deaths (45% of deaths), being ischaemic heart disease, stroke, hypertension (leading to heart failure) the major cause of these CVD related deaths. Periodontitis is also a chronic non-communicable disease (NCD) with a high prevalence, being severe periodontitis, affe...

Background: In Europe cardiovascular disease (CVD) is responsible for 3.9 million deaths (45% of deaths), being ischaemic heart disease, stroke, hypertension (leading to heart failure) the major cause of these CVD related deaths. Periodontitis is also a chronic non-communicable disease (NCD) with a high prevalence, being severe periodontitis, affe...

Background: Aim of this study was to compare coronally advanced flap (CAF) and composite restoration of the cement-enamel junction (CEJ) with or without connective tissue graft (CTG) for treatment of single maxillary gingival recession with non-carious cervical lesion (NCCL). Material and methods: Thirty patients with single gingival recessions...

Aims: To investigate the effect of defect morphology, bone thickness and examiner experience on the accuracy to detect the presence, the type and the depth of peri-implant defects with digital periapical radiographs (PAs) and cone beam computed tomography (CBCT) in an in vitro model. Methods: 36 implants were placed in fresh porcine rib bone wit...

Background: Furcation involvement and attachment loss are major predictors of tooth loss. Aim of this study was to describe specific designs for papilla preservation flaps (PPF) and minimally invasive surgery to be used in compromised molars and report proof of principle data with 3-16 year follow up in severely compromised molars due to the prese...

Background: The transition from a tooth requiring extraction to its replacement (with a dental implant) requires a series of clinical decisions related to timing, approach, materials, cost-effectiveness and the assessment of potential harm and patient preference. This workshop focused on the formulation of evidence-based consensus statements and c...

s Evidence-based oral health care requires a robust base of data that can be trusted, is applicable to the specific clinical scenarios and results in better health outcomes. Scientific publishing is a key aspect as it bridges innovation to clinical application and provides rigorous peer review and quality control to the process. Publishing has been...

Background Few studies have looked at professional assessment or patient perception of esthetics after root coverage procedures. The addition of connective tissue grafts (CTG) seems to improve esthetic outcomes. The objective of this a priori analysis was to compare esthetics after addition of CTG or a collagen matrix (CMX) to coronally advanced fl...

Background Implementation of the new classification of periodontal diseases requires careful navigation of the new case definitions and organization of the diagnostic process along rationale and easily applicable algorithms. The aim of this report is to describe the rationale for one such approach designed for clinical practice and education. Meth...