19 June 2025

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SMART Design Shows Feasibility for Clinical Trials When Treating Challenging Periodontal Cases

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Researchers from the Faculty of Dentistry, Oral & Craniofacial Sciences at King’s College London have conducted the first randomised controlled trial for the treatment of Grade III furcation-involved molars, an advanced and challenging clinical scenario.

Using the SMART design (Sequential, Multiple Assignment, Randomised Trial), the researchers conducted a novel feasibility study in conjunction with a trial. The results show how studies with personalised medicine designs—which incorporate patients’ own outcome measures along with clinical results—could be considered a viable design for clinical research trials in periodontology.

In periodontology, when bone loss occurs between the roots of multirooted teeth, a furcation involvement (FI) ensues. FI affects the prognosis of a tooth, with the most advanced Grade III having the worst chances of tooth survival over time. To date, no clear guidelines for the best treatment for Grade III FI exist.

“Our study is the first to demonstrate the feasibility of using a SMART trial design in periodontology, and it was the first randomised trial on the topic of Grade III FI molar teeth,” explains Dr. Priya Bahal, Academic Clinical Fellow from King’s College London.

“Findings revealed that open flap debridement led to greater reductions in probing pocket depths compared to non-surgical therapy, and notably, it highlighted the importance of combining clinical and patient-reported outcomes.”

The study also introduced the idea of patient-centred research through the involvement of a “patient champion” as a co-investigator. The patient champion was involved in several aspects of the study, from planning to participation in the steering committee, data interpretation, and manuscript preparation. It is the first time that a patient champion has had this level of involvement as a co-author in a randomised trial in periodontology.

These results demonstrate the feasibility of SMART designs in periodontology and beyond, and set the scene for future research studies to utilise more adaptable, personalised approaches.

The research was selected to be presented at the EuroPerio Conference in late May for the Jaccard Prize. The team was awarded the runner-up/second prize. The Jaccard-EFP Research Prize in Periodontology was instituted by the European Federation of Periodontology (EFP) and the Jaccard Foundation (University of Geneva) in 1995, aiming to promote research in Europe. The prize is awarded once every three years at the EuroPerio Conference.

Clinical and patient-reported outcomes in Grade III furcations: A randomised feasibility trial with SMART design was published in the Journal of Clinical Periodontology on 5 June 2025.

Source: https://onlinelibrary.wiley.com/doi/10.1111/jcpe.14134