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Based on baseline self-administered questionnaires, four lifestyle factors - physical activity, dietary habits, smoking, and alcohol consumption- were scored as either healthy (1 point) or unhealthy (0 point). An overall healthy lifestyle variable was calculated for each patient by summing the individual scores (ranging from 0 to 4 points), and its impact on clinical outcomes was analyzed. The primary outcome of the study was disease control (\u2264\u20094 residual probing pocket depth (PPD)\u2009\u2265\u20095\u00a0mm).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 120 patients were treated. At T1, a statistically significant association was observed between the overall lifestyle score and treatment response (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.029). Specifically, 55.1% of patients with healthy lifestyle behaviors (score 3\u20134) achieved the primary endpoint, compared to 29.0% and 32.5% of those with partial (score 2) or poor health attentiveness (score 0\u20131), respectively. Additionally, health-conscious individuals demonstrated better control of gingival inflammation, despite having comparable oral hygiene levels (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). In the logistic regression model, attentiveness to one\u2019s health (OR 3.39, 95% CI 1.13\u20139.47,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.020), normal body weight (OR 2.93, 95% CI 1.12\u20137.70,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.029) and percentage of sites with PPD\u2009\u2265\u20096\u00a0mm at baseline (OR 0.90, 95% CI\u2009=\u20090.84\u20130.97,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006) were significantly associated with treatment outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Adherence to positive healthy lifestyle factors contributes to better clinical outcomes following periodontal therapy in patients with stage III\/IV periodontitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical relevance<\/jats:title>\n                    <jats:p>The adoption of healthy lifestyle behaviors should be considered as part of the overall management strategy for patients with severe periodontitis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00784-025-06668-9","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T04:12:31Z","timestamp":1763957551000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of lifestyle behaviors on clinical outcomes of steps 1 and 2 of periodontal therapy in stage iii-iv periodontitis: a cohort study"],"prefix":"10.1007","volume":"29","author":[{"given":"Federica","family":"Romano","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Baima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Llerena-Velasquez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Siccardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Tonello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Vernero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide Giuseppe","family":"Ribaldone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Aimetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,24]]},"reference":[{"key":"6668_CR1","doi-asserted-by":"publisher","DOI":"10.1111\/jre.13337","author":"GG Nascimento","year":"2024","unstructured":"Nascimento GG, Alves-Costa S, Romandini M (2024) Burden of severe periodontitis and edentulism in 2021, with projections up to 2050: the global burden of disease 2021 study. 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