CKD + stage III periodontitis: an RCT to test whether NSPT preserves teeth and masticatory function

Periodontitis and chronic kidney disease (CKD) share a bidirectional inflammatory relationship that worsens systemic and oral outcomes alike. Despite growing epidemiological evidence linking the two conditions, high-quality interventional data on the impact of periodontal treatment in CKD patients remain scarce. This randomised controlled trial protocol, developed at the Ninth People's Hospital affiliated to Shanghai Jiao Tong University, addresses a clinically relevant but underexplored question: can active non-surgical periodontal therapy (NSPT) combined with structured supportive periodontal care (SPC) reduce tooth loss and improve masticatory function in patients simultaneously affected by stage III periodontitis and CKD?

The trial will enrol 86 patients meeting both diagnoses, randomised 1:1 to either the experimental arm — receiving full active NSPT (scaling and root planing) followed by scheduled SPC — or the control arm, limited to oral hygiene instruction and periodic monitoring. The 24-month follow-up includes six assessment timepoints (baseline and 3, 6, 12, 18, 24 months), enabling longitudinal tracking of periodontal stability. Primary outcome is the incidence of tooth loss attributable to periodontitis. Secondary outcomes encompass the absolute number of teeth lost, masticatory performance, standard clinical periodontal parameters (probing depth, clinical attachment level, bleeding on probing, plaque index), and oral health-related quality of life.

As a protocol paper, the study does not yet report clinical results. However, its design deserves attention for several reasons. First, it targets a population — CKD patients with advanced periodontitis — that is systemically compromised, often medicated with immunosuppressants or anticoagulants, and at elevated risk for both tooth loss and functional impairment. Second, masticatory function is included as an explicit endpoint, acknowledging that tooth retention alone is insufficient if functional integration is lost. Third, the SPC component formalises what many clinicians apply empirically, providing a framework to test its long-term protective value.

For periodontists and implantologists, the clinical relevance is twofold. In the short term, evidence from this trial could justify more aggressive periodontal intervention protocols in nephrology referral pathways, where oral health is frequently deprioritised. In the longer term, if NSPT plus SPC demonstrates a measurable reduction in tooth loss and functional decline, it would strengthen the case for interdisciplinary co-management of CKD patients — positioning periodontal therapy not merely as adjunctive care, but as a component of systemic disease management. The implantological dimension also warrants consideration: preserving the natural dentition in a medically compromised patient is always preferable to rehabilitation with implants, whose outcomes in CKD remain poorly characterised. This trial, once completed, may provide the evidence base needed to reshape treatment priorities in this patient cohort.