About

Cristiano Susin, DDS, MS, PhD, is the Ray C. Williams Orapharma Distinguished Professor and chair of the Department of Periodontology, Endodontics and Dental Hygiene at the University of North Carolina at Chapel Hill. He is a professor of periodontology and holds the Orapharma Distinguished Professorship. Prior to joining UNC in 2018, he was a professor in the Department of Periodontics at Augusta University Dental College of Georgia, where he also served as the director for the Laboratory for Applied Periodontal and Craniofacial Research and the Center for Clinical and Translational Research. Susin received his Doctor of Dental Surgery degree from the Federal University of Rio Grande do Sul in Porto Alegre, Brazil. He earned his master’s degree specializing in periodontology from Lutheran University of Brazil, and his doctorate degree from the University of Bergen in Norway. He completed his residency program at the Medical College of Georgia and became a diplomate of the American Board of Periodontology. His research has been recognized with awards such as the R. Earl Robinson Periodontal Regeneration Award from the American Academy of Periodontology for his study on periodontal healing following reconstructive surgery. Susin has participated in the 2017 American Dental Educators Association Leadership Institute and has published extensively, including textbooks and hundreds of journal articles. His work includes invited presentations and contributions to the field of periodontology.

Research topics

• Internal medicine
• Medicine
• Dentistry
• Biology
• Orthodontics
• Surgery
• Endocrinology
• Immunology
• Gastroenterology

Selected publications

• The efficacy of combining adjuvants with non‐surgical periodontal therapy in individuals with type 2 diabetes: A Bayesian network meta‐analysis

  UNC Libraries · 2026-04-17

  articleOpen access1st authorCorresponding

  AIM: This Bayesian network meta-analysis of randomized controlled trials assessed the effect of adjuvant periodontal treatment in both periodontal and HbA1c outcomes in adult individuals with type 2 diabetes (T2DM). MATERIALS AND METHODS: A systematic search was done up to February 2023 comparing sub-gingival debridement (SD) in combination with local or systemic adjuvant treatment with SD alone for individuals with T2DM. The primary outcomes were changes in absolute HbA1c levels and full-mouth probing depth reported at 3- to 6-month post-treatment. R ESULTS: Seventy-two eligible publications evaluating 27 adjuvant treatments were retrieved. The combination of SD and systemic antibiotic metronidazole or SD and antioxidant alpha lipoic acid provided, respectively, 1.4% (95% credible interval [CrI] 0.48; 2.20) and 2.4% (95% CrI 1.50; 3.30) more significant improvement on HbA1c levels, and 0.89 mm (95% CrI 0.23; 1.50) and 0.92 mm (95% CrI 0.02; 0.92) greater periodontal probing depth reductions. Other adjuvant treatments provided added benefit to the periodontal outcomes without discernible effects on HbA1c. CONCLUSIONS: Adjuvant use of metronidazole or alpha lipoic acid was the best adjunct option to provide clinically meaningful HbA1c levels and probing depth reductions. However, no strong recommendation can be drawn due to the scarcity of studies for each adjuvant treatment and the low certainty of the resultant evidence.

  PublisherDOI

• Evaluation of Two Alloplastic Biomaterials in a Critical-Size Rat Calvarial Defect Model

  Journal of Functional Biomaterials · 2025-06-06 · 1 citations

  articleOpen accessSenior author

  AIM: to evaluate the bone regeneration capacity of two alloplastic biomaterials in a critical-size rat calvarial defect model. METHODS: A total of 80 rats were randomized into 8 groups of 10 animals each. An Ø8 mm, critical-size calvarial defect was created, and the following treatments were randomly allocated: sham surgery, deproteinized bovine bone mineral (DBBM) + collagen membrane (CM), poly-(lactic-co-glycolic-acid) (PLGA)-coated pure phase β-tricalcium phosphate (β-TCP), or PLGA-coated 60% hydroxyapatite (HA):40%β-TCP. Animals were allowed to heal for 2 and 6 weeks. Microcomputed tomography (μCT) was used to evaluate mineralized tissue and biomaterial displacement. Histological samples were used to evaluate new bone formation. RESULTS: μCT analysis showed no significant differences among groups for total volume of mineralized tissue or residual biomaterials. DBBM + CM showed significantly increased horizontal biomaterial displacement at 2 weeks but not at 6 weeks. Histological analysis showed that sham surgery had a significantly higher percentage of bone area fraction than the DBBM + CM and PLGA + β-TCP at 2 weeks, but not at 6 weeks. Residual biomaterial area fraction showed no significant differences among experimental groups at any healing time. CONCLUSIONS: The alloplastic biomaterials showed suitable construct integrity and retention in the defect. All biomaterials were associated with limited new bone formation comparable to the sham surgery control.

  PublisherDOI

• Inflammasome targeting for periodontitis prevention is sex dependent

  Proceedings of the National Academy of Sciences · 2025-10-27 · 3 citations

  articleOpen access

  Inflammasome initiates inflammation via the maturation of interleukin-1 beta (IL-1β). Periodontitis is a prevalent, male-biased disease characterized by inflammation-driven bone loss, yet the mechanism(s) of this sex bias is unknown. This study explored whether enhanced inflammasome represents a causal mechanism for this bias. Analyses of three separate human studies (>6,200 samples) show that males have significantly higher IL-1β in the gingival crevicular fluid than females during health and periodontitis. This pattern is experimentally reproduced with different versions of the ligature-induced periodontitis mouse model where males show greater IL-1β secretion than females. The inflammasome drives bone resorption in males but not females as revealed by analyses of inflammasome gene-deletion mice. Pharmacologic treatment with a caspase-1/4 inhibitor reduces inflammatory cell infiltration, dampens osteoclastogenesis signaling (via the receptor activator of nuclear factor-kappa B pathway), and prevents bone resorption in males but not females during experimental periodontitis. While ovariectomized females show no change in their nonresponsiveness to caspase-1/4 inhibition, orchiectomized males no longer respond to the inhibition, suggesting the importance of an intact male reproductive system in the mediation of this inhibition. Thus, our study identifies inflammasome activation as causal for male-biased experimental periodontitis and supports sex-stratified studies to foster future advancement of inflammasome therapeutics in periodontics.

  PublisherOA PDFDOI

• Longitudinal Assessment Using Entrustable Professional Activities: Key Steps for Implementation in Dental Education

  Journal of Dental Education · 2025-05-05 · 2 citations

  articleOpen access

  PURPOSE/OBJECTIVES: Curriculum evolution calls for incorporating contemporary pedagogical practice. In 2021, the UNC ASOD began the implementation of a new curriculum. One of the unique aspects was a shift from traditional single competency assessments to a longitudinal assessment system using entrustable professional activities (EPAs) for summative entrustment decisions. This paper describes the process and outcomes of determining entrustment and practice readiness for the dental Class of 2024. METHODS: A six-step process leading to determination of practice readiness is outlined, with the final step culminating in summative decisions for entrustment and readiness for safe and independent practice post-graduation. RESULTS: All 91 (100%) learners achieved Statements of Awarded Responsibility (STARs) or competence in all EPAs by graduation, meeting thresholds, and practice readiness criteria. This progression varied by EPA, with some tasks completed earlier in the curriculum and others requiring more time or being impacted by the timing of supplemental assessments. Delays in STAR designation occurred for four learners. No STARs were rescinded. CONCLUSION: A longitudinal assessment framework with multiple assessments by multiple evaluators on cases of varying complexity in an authentic work-based environment was successful in preparing practice-ready graduates and ensuring the capability of learners to safely and independently perform professional tasks. Monitoring learners' performance quality, independence, and progression over time and in varying contexts contributes to a greater ability to ascertain learners' practice readiness. The EPA framework facilitated operationalizing longitudinal assessment by providing a comprehensive and future-focused approach to evaluating clinical competence and ensuring public trust.

  PublisherOA PDFDOI

• Evaluation of Two Alloplastic Biomaterials in a Critical-Size Rat Calvarial Defect Model

  UNC Libraries · 2025-07-02

  articleOpen access1st authorCorresponding

  Aim: to evaluate the bone regeneration capacity of two alloplastic biomaterials in a critical-size rat calvarial defect model. Methods: A total of 80 rats were randomized into 8 groups of 10 animals each. An Ø8 mm, critical-size calvarial defect was created, and the following treatments were randomly allocated: sham surgery, deproteinized bovine bone mineral (DBBM) + collagen membrane (CM), poly-(lactic-co-glycolic-acid) (PLGA)-coated pure phase β-tricalcium phosphate (β-TCP), or PLGA-coated 60% hydroxyapatite (HA):40%β-TCP. Animals were allowed to heal for 2 and 6 weeks. Microcomputed tomography (μCT) was used to evaluate mineralized tissue and biomaterial displacement. Histological samples were used to evaluate new bone formation. Results: μCT analysis showed no significant differences among groups for total volume of mineralized tissue or residual biomaterials. DBBM + CM showed significantly increased horizontal biomaterial displacement at 2 weeks but not at 6 weeks. Histological analysis showed that sham surgery had a significantly higher percentage of bone area fraction than the DBBM + CM and PLGA + β-TCP at 2 weeks, but not at 6 weeks. Residual biomaterial area fraction showed no significant differences among experimental groups at any healing time. Conclusions: The alloplastic biomaterials showed suitable construct integrity and retention in the defect. All biomaterials were associated with limited new bone formation comparable to the sham surgery control.

  PublisherDOI

• Periodontal Manifestations of Systemic Diseases

  Journal of Periodontal Research · 2025-09-16 · 4 citations

  review1st author

  This paper provides a detailed analysis of systemic diseases associated with periodontal tissue loss, focusing on their clinical presentation and etiopathogenesis. It also introduces a framework for categorizing these diseases according to their principal pathological pathways and their periodontal effects. Periodontitis arises from a disruption of host-microbe homeostasis, which leads to a dysbiotic microbiota, chronic inflammation, and subsequent periodontal tissue loss. Complex systemic diseases, particularly those causing systemic inflammation or having an autoimmune component (e.g., diabetes mellitus, osteoporosis, arthritis, and inflammatory bowel disease), can exacerbate pre-existing periodontal inflammation and cause further tissue loss. As their inflammatory and pathological pathways are intertwined with periodontitis, their periodontal manifestations are not considered distinct forms of the disease. In contrast, other systemic diseases disrupt host-microbe homeostasis by causing specific defects in the immune response, whereas others impair tissue metabolism or disrupt the physiology and integrity of epithelial and connective tissues. These diseases can lead to significant periodontal destruction and are considered distinct forms of periodontitis. Examples include Down syndrome, leukocyte adhesion deficiency syndromes, Papillon-Lefèvre syndrome, Haim-Munk syndrome, Chediak-Higashi syndrome, neutropenia, primary immunodeficiency diseases, Cohen syndrome, glycogen storage diseases, Gaucher disease, hypophosphatasia, hypophosphatemic rickets, Hajdu-Cheney syndrome, epidermolysis bullosa, hypoplasminogenemia, and Ehlers-Danlos syndrome. A third category encompasses diseases that induce periodontal tissue loss through mechanisms independent of periodontitis. Examples of this group include Langerhans cell histiocytosis, hyperparathyroidism, and giant cell granulomas. In conclusion, systemic diseases contribute to periodontal tissue loss through overlapping inflammatory pathways, immune dysfunction, or other independent mechanisms. Grouping these diseases by their primary pathological pathways offers a clearer understanding of their effect on periodontal health. This framework may also help direct research toward uncovering shared and unique mechanisms of systemic disease-related periodontal pathology, potentially leading to more targeted therapies and improved disease management.

  PublisherDOI

• Necrotizing Periodontal Diseases: Epidemiology, Clinical Features, and Etiopathogenesis

  Journal of Periodontal Research · 2025-09-23 · 2 citations

  review

  Necrotizing periodontal diseases (NPDs) are a group of clinical conditions characterized by necrosis of the gingival, periodontal, and/or oral mucosa. They include necrotizing gingivitis (NG), necrotizing periodontitis (NP), necrotizing stomatitis (NS), and noma. This study reviewed the epidemiology, etiology, and pathogenesis of these diseases. NPDs are characterized by distinct clinical features, including pain, inflammation, tissue necrosis, and unprovoked gingival bleeding, and can lead to rapid destruction of the soft and hard tissues of the periodontium and/or oral mucosa. A meta-analysis conducted in this study estimates the overall prevalence of NG was 0.04%, and is highest for Latin America (0.08%) and Asia (0.07%), among HIV-positive individuals (0.07%), and drug addicts (0.08%). The prevalence of NPD lesions is higher in young than in older age groups, particularly those with severe malnutrition. NPDs are opportunistic infections caused by the oral biofilm, in the presence of other etiological and predisposing factors. Although these causes are somewhat different from the etiological factors of periodontitis, the distinction is not well defined. Pre-existing gingival inflammation and/or periodontitis and a mixed infection are necessary causes but are not sufficient for the development of NPDs. These etiological factors, together with one or more other predisposing factors, including immunosuppression, severe psychological stress, severe malnutrition, heavy smoking, heavy alcohol consumption, uncontrolled diabetes, and HIV infection, significantly increase the risk of the development of NPDs. We propose a model that describes the causal pathway of NPDs whereby an opportunistic infection in predisposed individuals leads to microbial invasion of the gingival tissues and the development of local inflammation and tissue necrosis, which can be followed by destruction of the soft and hard oral tissues. NPDs are phenotypically distinct from conventional forms of periodontitis. However, it is unclear whether these diseases are also pathophysiologically different, as there is insufficient understanding of the underlying biological mechanisms that lead to their development.

  PublisherDOI

• Aligning dental curriculum to support an entrustable professional activities framework: Structure, instruction, assessment, and infrastructure

  Journal of Dental Education · 2024-08-03 · 2 citations

  article
  PublisherDOI

• Supportive periodontal care with or without subgingival instrumentation: Microbiological results of a 2‐year randomized clinical trial

  Journal Of Clinical Periodontology · 2024-07-02 · 1 citations

  article

  AIM: To compare the subgingival microbiota of patients receiving supportive periodontal care (SPC) with and without subgingival instrumentation, over 2 years. MATERIALS AND METHODS: This study was a randomized clinical trial that included 62 participants (50.97 ± 9.26 years old; 40 females) who completed non-surgical periodontal therapy. Participants were randomly assigned to receive oral prophylaxis with oral hygiene instructions alone (test) or in combination with subgingival instrumentation (control) during SPC. Pooled subgingival biofilm samples were obtained from four sites per patient at SPC baseline and at 3, 6, 12, 18, and 24 months. Real-time polymerase chain reaction was used for absolute quantification of Eubacteria and the target bacteria Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola. Data were analysed using generalized estimating equations, taking into consideration the clustering of observations within individuals. RESULTS: No significant differences were found between the experimental groups regarding the mean counts of Eubacteria and target bacteria, as well as the periodontal parameters at the sampled sites. Although significant variability in bacterial counts was present during SPC, all counts after 2 years were not statistically different from those at baseline. Bacterial counts were associated with the presence of plaque, bleeding on probing, mean probing depth ≥3 mm, and follow-up period. CONCLUSIONS: SPC with or without subgingival instrumentation can result in comparable subgingival microbiological outcomes. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov: NCT01598155 (https://clinicaltrials.gov/study/NCT01598155?intr=supragingival%20control&rank=4#study-record-dates).

  PublisherDOI

• Estimating disease prevalence from partially-sampled clusters using the conditional linear family for multivariate Bernoulli data

  Journal of Statistical Research · 2024-08-14

  articleOpen accessSenior author

  In periodontal disease surveillance in human populations, full-mouth clinical examinations to classify the disease status of individuals are the gold standard for estimating periodontitis prevalence. However, conducting full-mouth exams is resource intensive, time consuming, and costly, especially in studies involving thousands of participants. Partial-recording protocols have been utilized in oral health surveys worldwide to gather correlated binary outcomes of periodontal disease on selected teeth in lieu of full-mouth exams. Since the use of partial-recording protocols tends to underestimate disease prevalence, a statistical distributional approach considering the pattern of tooth-level disease in the mouth was proposed to substantially reduce bias for the estimation of periodontitis prevalence. This approach employed multivariate Bernoulli distributions for observation (tooth)-level disease indicators to define formulae for the prevalence of disease (periodontitis) at the cluster (person)-level for various full-mouth case definitions. In turn, prevalence estimators were based on plug- in estimates of parameters from a conditional linear family for binary data gathered under partial recording protocols. Work in this article extended existing prevalence estimators for simple case definitions based on single clinical measures of tooth-level periodontal disease to a definition of severe periodontitis using two measures as defined by the Centers for Disease Control and Prevention and the American Academy of Periodontology, and later adopted by the 2017 World Workshop in Periodontology. Simulations evaluated the finite-sample performance of the proposed estimators and their confidence intervals for three established partial-recording protocols. In general, the prevalence estimators performed well relative to bias and coverage when tooth-level probabilities of disease and within-mouth correlation structures were correctly specified and even when the pattern of tooth-pair correlations was misspecified. Journal of Statistical Research 2024, Vol. 58, No. 1, pp. 3-31.

  PublisherOA PDFDOI

Frequent coauthors

• Rui Vicente Oppermann

  86 shared

• Ulf M. E. Wikesjö

  University of North Carolina at Chapel Hill

  79 shared

• Jasim M. Albandar

  Temple University

  62 shared

• Tiago Fiorini

  Universidade Federal do Rio Grande do Sul

  43 shared

• Cassiano Kuchenbecker Rösing

  Universidade Federal do Rio Grande do Sul

  39 shared

• Alex Nogueira Haas

  Universidade Federal do Rio Grande do Sul

  31 shared

• Ola Haugejorden

  University of Bergen

  29 shared

• Claudia Nonnenmacher

  Philipps University of Marburg

  26 shared

Education

• Certificate in Periodontics

  Medical College of Georgia | Augusta University

  2011

• PhD

  Universitetet i Bergen

  2004

• MSD/Certificate -- Periodontics

  Universidade Luterana do Brasil

  1999

• DDS

  Universidade Federal do Rio Grande do Sul

  1996

Awards & honors

• R. Earl Robinson Periodontal Regeneration Award from the Ame…