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Background: There is substantial evidence that smokers present a less favorable response following regenerative periodontal surgery. However, there are no reports to date on the response to regenerative procedures in chronic cannabis smokers. In the present case study, we discuss the periodontal outcomes of reparative and regenerative surgical treatment in a cannabis consumer patient with generalized stage III grade C periodontitis., Methods and Results: We report the case of a young adult cannabis consumer patient diagnosed with generalized stage III grade C periodontitis who had a probing depth (PD) of ≥ 4 at 18% of sites and of ≥ 7 mm at 12% of sites and radiographically confirmed generalized interproximal bone loss with horizontal and angular defects that reached the middle and apical third of the roots. An appropriate sequence of therapy based on the recommendations in the Clinical Practice Guideline (CPG) involving reparative and regenerative surgical procedures (steps 1-3) was followed. Clinical outcomes at 6 months included a decrease in PD of up to 7 mm and radiographic evidence of newly formed bone in the bony defects., Conclusion: The present case study demonstrates the use of regenerative periodontal procedures as part of a stepwise treatment approach, with different interventions at each step, to successfully manage intrabony periodontal defects in a healthy young adult male cannabis consumer., Key Points: Smoking is a well-documented dose-dependent risk factor for periodontal disease, with a demonstrated negative effect on periodontal therapy outcomes. However, the usefulness of regenerative periodontal therapy in cannabis smokers has not been established to date. This case presents new information in that it is the first report to show that appropriate periodontal treatment can stabilize the periodontal disease and that regenerative therapies were successful in healing intrabony periodontal defects in a healthy young adult cannabis user. The keys to successful management of this case are: -Attention to detail in all aspects of therapy. -Patient compliance as a co-therapist by maintaining effective plaque control. -Patient acceptance of supportive care recommendations. The primary limitations of this case study are: -The main limitation of this study is that a single clinical case study is too small to draw conclusions about regenerative treatment in patients who use cannabis. -The follow-up assessment times were not sufficient to determine the long-term success of regenerative surgery. -Patient compliance with oral hygiene recommendations and supportive care are key to achieving long-term success in regenerative therapy., Plain Language Summary: Background: Smokers have a worse response to regenerative periodontal surgery. There are no reports on how cannabis smokers respond to regenerative procedures. This case study discusses how periodontal surgery worked in a young adult patient with severe periodontitis who was a frequent cannabis user. After 6 months of an appropriate sequence of therapy including strict regenerative surgical procedures, there was new bone filling in the bony defects., Conclusions: This case shows that regenerative periodontal procedures can successfully treat intraosseous periodontal defects in a healthy young adult male cannabis user., (© 2025 American Academy of Periodontology.)

Background: Preoperative malnutrition is a known risk factor for postoperative complications following total joint arthroplasty (TJA); however, there is scant literature comparing which nutritional index is best at predicting these outcomes. The purpose of this study was to investigate the utility of the Maastricht index, Onodera's Prognostic Nutritional Index, the Geriatric Nutritional Risk index, and a novel, modified Geriatric Nutritional Risk Index (mGNRI) in predicting periprosthetic joint infection (PJI), wound complications (WCs), readmission, and reoperation rates after TJA., Methods: A single-center, retrospective cohort study was performed of patients who underwent primary TJA from January 2016 to December 2021. The 90-day preoperative albumin, prealbumin, and total lymphocyte count were collected. Outcome measures were PJI, WC, readmission, and return to the operating room. Youden's index (YI) and Receiver operator characteristic curves were used to determine optimal cutoff points. Multivariable logistic regression was used to adjust for potential confounders, including body mass index, age, and the Charlson comorbidity index., Results: There were 1,575 patients included in the study. The mGNRI had the greatest accuracy (area under the curve = 0.633; optimal cutoff point = 92.8) in predicting postoperative adverse outcomes. Complication rates were significantly higher in the low mGNRI group (≤ 92.8). When controlled for body mass index, Charlson comorbidity index, and age, the odds of PJI, WC, readmission, and reoperation in patients who had low mGNRI were 6.61 (P = 0.005), 3.04 (P = 0.021), 2.25 (P = 0.020), and 2.75 (P = 0.024), respectively., Conclusions: The mGNRI is an easy-to-calculate nutritional index and an excellent predictor of postoperative complications following TJA. The mGNRI outperformed Geriatric Nutritional Risk index, Maastricht index, and Onodera's Prognostic Nutritional Index in predicting postoperative complications. Our results suggest that patients who fall below the mGNRI threshold of 92.8 should be carefully considered for nutritional optimization prior to TJA., (Copyright © 2025 Elsevier Inc. All rights reserved.)