ArticleJournal of periodontology2026
Periodontal inflamed surface area (PISA) system and components: Potential for exploring the periodontal systemic interface.
Article in Journal of periodontology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe periodontal inflamed surface area (PISA) estimates the area of inflammatory burden of periodontal disease. This methodological study accessed PISA and its constituents, and systemic C-reactive protein correlations in an attempt to define different tools to investigate the periodontal-systemic interface.
methodsData from the Buffalo OsteoPerio cross-sectional study (1997-2001) were used. The full-mouth periodontal probing depth (PPD) and clinical attachment loss (CAL) at six sites per tooth, and marginal bleeding (MB) at three sites per tooth from 713 post-menopausal women were included. Fasting blood and saliva log-transformed C-reactive protein values were used.
resultsA significant increase of MB (30 ± 20/43 ± 26), CAL (1.8 ± 0.3/3.1 ± 0.8), PPD (1.7 ± 0.2 /2.3 ± 0.4), PISA (220.5 ± 162.5/472.1 ± 324.6), and C-reactive protein (medians in mg/L), for saliva (0.43/0.67) and serum (2810/3882), was observed with increasing severity of periodontitis. Overall, the highest intercorrelations occurred for indices based on similar periodontal measures, as observed for PPD of whole mouth and of sites measured for bleeding (r = 0.960). Correlations between PISA and C-reactive protein were weak for saliva [maximum of 0.088 (0.015, 0.161) and serum (maximum 0.048 (-0.027, 0.123)]. MB presented a consistent pattern of correlations with C-reactive protein, even weak [maximum of 0.254 (0.085, 0.409) for severe periodontitis]. For serum C-reactive protein, no significant correlations were found.
conclusionsThe extent of MB consistently correlated to C-reactive protein, while a higher correlation with PISA could not be determined. The results of the present investigation do not support the use of PISA as a clinical tool in place of, or adjuvant to, the extent of gingival bleeding present when exploring periodontal inflammation and its potential interface with systemic conditions. PLAIN LANGUAGE SUMMARY: The diagnosis of periodontal disease may be performed using different tools. In this study, the authors tested a tool that evaluates the area of inflamed periodontium (PISA), and its components to evaluate the periodontal-systemic interface, using C-reactive protein as a marker of systemic inflammation. Interestingly, the percentage of sites positive for bleeding showed higher correlations with C-reactive protein than PISA. Although PISA has gained some followers, our results showed that its calculation may not be needed for evaluating the periodontal-systemic interface.
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