Sexual dimorphism in geriatric periodontology and implant dentistry

Aging is a progressive biological process characterized by accumulating molecular and cellular damage and functional decline. Although some clinical attachment and alveolar bone loss is common in older adults, severe periodontitis is not an inevitable consequence of aging. Sexual dimorphism (SD), encompassing genetic, epigenetic, hormonal, and socio-behavioral differences between sexes, may modify disease susceptibility, progression, and treatment response in geriatric periodontal and implant care. Most available epidemiological evidence generally indicates a higher prevalence and severity of periodontitis in men. Differences in oral hygiene and healthcare utilization partly explain this disparity, but sex-specific biological mechanisms may also contribute. Men may exhibit stronger pro-inflammatory responses and differential regulation of sex steroid-responsive genes, while genome-wide analyses support genotype-sex interactions affecting disease expression. Advanced age is associated with a modestly reduced response to non-surgical periodontal therapy (NSPT), with some evidence of slightly less favorable outcomes in older men, although the clinical relevance appears limited. In implant dentistry, SD may influence bone morphology and density, radiographic interpretability, and preoperative risk assessment. Elderly-specific data, however, do not identify sex as an independent predictor of early implant failure or long-term survival. A possible male disadvantage has been reported for composite implant success in complex rehabilitations, whereas the evidence evaluating the sex effect on peri-implant mucositis or peri-implantitis in older patients is limited. Sex-related biological factors and gender-related behaviors should therefore be incorporated into individualized risk assessment, but current evidence remains insufficient to support sex-specific therapeutic protocols.