Quantifying Periodontal Inflammatory Burden: A Conceptual Clinical Framework Integrating Periodontal Inflamed Surface Area (PISA) and High-Sensitivity C-reactive Protein (Hs-CRP) for Oral-Systemic Health.

Periodontitis is a chronic inflammatory disease characterized by biofilm-driven tissue destruction and ulcerated pocket epithelium, which may contribute to systemic low-grade inflammation. While conventional periodontal parameters are essential for diagnosis and staging, they do not directly quantify the biologically active inflammatory surface exposed to the bloodstream. This report proposes a clinically feasible framework integrating the periodontal inflamed surface area (PISA) and high-sensitivity C-reactive protein (hs-CRP) to quantify the oral-systemic inflammatory burden. By synthesizing current evidence, this conceptual clinical framework suggests a standardized observational protocol applicable in routine practice. A three-time-point protocol is proposed: a baseline (T0) assessment of periodontal status, PISA, and hs-CRP; an optional intermediate reassessment (T1) to contextualize inflammatory kinetics; and a follow-up (T2, 4-12 weeks) to evaluate sustained changes after periodontal therapy. The primary outcome focuses on the correlation between changes in PISA and hs-CRP. Ultimately, the integrated PISA-hs-CRP framework provides a biologically meaningful and reproducible method to translate periodontal findings into quantifiable systemic inflammatory metrics, supporting interdisciplinary communication and real-world clinical audits. This report presents a proposed multi-time-point observational clinical audit protocol; no empirical data are reported.