Precision periodontology through periodontal endophenotyping: A narrative review

Periodontal disease is a chronic inflammatory disease that is influenced by microbial, immunological, genetic, and systemic factors. The 2017 World Workshop staging and grading framework has improved clinical categorization. However, it does not consider underlying biological diversity among patients with similar clinical presentations. In psychiatry, endocrinology, and pulmonology, the concept of endophenotypes connects genotype, environmental factors, and clinical outcome. Evidence from periodontology suggests that genetic and epigenetic variation, local microbiology, immunoinflammatory responses, chronic systemic conditions, and behavioral factors form biologically distinct subgroups. This review aims to provide current evidence that supports the concept of periodontal endophenotypes and discusses their role in diagnostics, risk assessment, and precision therapy. Standardized markers are yet to be established. This paper seeks to identify current gaps in understanding and outline future directions for research in precision periodontology. The findings could pave the way for more personalized treatment strategies tailored to individual patient profiles. By addressing these gaps, researchers may enhance the effectiveness of interventions and improve overall patient outcomes in periodontal care.