{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:25:04Z","timestamp":1786944304253,"version":"build-2736575974"},"reference-count":113,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T00:00:00Z","timestamp":1786838400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T00:00:00Z","timestamp":1786838400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Periodontology 2000"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Periodontal and peri\u2010implant diseases are multifactorial inflammatory conditions influenced by microbial, host, hormonal, genetic, and behavioral factors. Although sex\u2010based differences in immune and inflammatory responses are well recognized in medicine, the extent to which biologic sex and hormonal status influence the prevalence, severity, and biologic markers of periodontal and peri\u2010implant diseases remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This narrative review synthesizes available human and animal evidence to evaluate whether sexual dimorphism exists in periodontal disease and peri\u2010implant disease expression and to synthesize available evidence regarding hormonal status and biologic markers as potential modifying factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comprehensive literature search was conducted to identify human and animal studies evaluating sex\u2010associated differences in periodontal disease, peri\u2010implant mucositis, and peri\u2010implantitis. Sixty\u2010eight human studies and 29 animal studies were included. Human studies encompassed epidemiologic, clinical, and biomarker\u2010based investigations, while animal studies included direct male\u2013female comparisons and female\u2010only hormonal deficiency models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Most population\u2010based human studies reported a higher prevalence or severity of periodontitis in males, characterized by greater clinical attachment loss and probing depths. However, several studies \u2013 particularly those involving adolescents \u2013 reported no sex differences, and a minority demonstrated female\u2010predominant gingival inflammation, often in hormonally active life stages. In peri\u2010implant disease, findings were largely inconsistent, with most studies reporting no significant association between biologic sex and peri\u2010implantitis, while smaller subsets identified either male or female sex as a potential risk factor. Animal studies demonstrated heterogeneous sex\u2010associated outcomes in direct male\u2013female comparisons. In contrast, female\u2010only estrogen\u2010deficiency models consistently showed increased periodontal destruction and impaired peri\u2010implant bone remodeling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Current evidence does not support uniform or universal sexual dimorphism in periodontal or peri\u2010implant disease. Rather, the available literature remains heterogenous and largely exploratory, with observed differences varying according to hormonal status, age, inflammatory profile, and behavioral and environmental exposures. Across both human and animal studies, estrogen deficiency emerged as a consistent modifier of periodontal and peri\u2010implant outcomes across species. Future studies incorporating prospective hormonal stratification, biologic\u2010marker analysis, and large\u2010scale epidemiologic datasets may help clarify multifaceted risk patterns.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/prd.70071","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T04:52:56Z","timestamp":1786942376000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond biologic sex: Exploratory insights into the heterogeneity of hormonal and contextual drivers of periodontal and peri\u2010implant outcomes"],"prefix":"10.1111","author":[{"given":"Caitlin","family":"Neapole","sequence":"first","affiliation":[{"name":"University of California at Los Angeles School of Dentistry  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Gettas","sequence":"additional","affiliation":[{"name":"University of 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