Impact of Traditional and Alternative Nicotine-Containing Product Use on Non-Surgical Periodontal Therapy: A Systematic Review and Network Meta-Analysis.

Authors

Orsolya Vámos, Péter Komora, Noémi Gede, Kata Kelemen, Márta Losonczi, Alexander Schulze Wenning, Gábor Varga, Péter Hegyi, Barbara Kispélyi

Published in

Dentistry journal. Volume 14. Issue 10. Sep 22, 2026. Epub Sep 22, 2026.

Abstract

Background/Objectives: Alternative nicotine-containing products have gained popularity in recent years. Our aim is to compare clinical periodontal outcomes following non-surgical periodontal therapy (NSPT) among patients with periodontitis according to nicotine exposure status: cigarette smokers (CS), former smokers (FS), quitters (Q), users of electronic cigarettes (EC), smokeless tobacco users (ST), and non-smokers (NS). Methods: A systematic search of four electronic databases (PubMed, EMBASE, Web of Science, CENTRAL) was performed until January 2025. Sixty-seven studies were included in the qualitative synthesis, of which 56 studies were included in a frequentist network meta-analysis. Two researchers independently collected data on probing pocket depth (PPD), clinical attachment loss, bleeding on probing, plaque index, full mouth plaque score, gingival index, and gingival crevicular fluid volume. Results: NS had significantly higher change in PPD compared with CS (MD: 0.25; CI: 0.13, 0.37; 50 studies; 1359 patients; moderate certainty), EC (MD: 0.98; CI: 0.47, 1.49; 2 studies; 56 patients; very low certainty), and ST (MD: 0.99; CI: 0.49, 1.49; 2 studies; 82 patients; low certainty). Q (MD: 0.02; CI: -0.56, 0.60; 2 studies; 52 patients; low certainty) and FS (MD: 0.03; CI: -0.62, 0.69; 4 studies; 267 patients; low certainty) did not differ significantly from NS. In secondary outcomes, NS, FS, or Q were ranked first. Conclusions: FS and Q showed no statistically significant differences from NS; EC and ST generally had less favorable treatment rankings than CS. The certainty of evidence varied across exposure groups and outcomes. Further studies are needed to support firm clinical recommendations.

PMID:
42930382
Bibliographic data and abstract were imported from PubMed on 26 Oct 2026.

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