1
|
De Lauretis A, Øvrebø Ø, Romandini M, Lyngstadaas SP, Rossi F, Haugen HJ. From Basic Science to Clinical Practice: A Review of Current Periodontal/Mucogingival Regenerative Biomaterials. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2308848. [PMID: 38380549 PMCID: PMC11077667 DOI: 10.1002/advs.202308848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/23/2024] [Indexed: 02/22/2024]
Abstract
Periodontitis is a dysbiosis-driven inflammatory disease affecting the tooth-supporting tissues, characterized by their progressive resorption, which can ultimately lead to tooth loss. A step-wise therapeutic approach is employed for periodontitis. After an initial behavioral and non-surgical phase, intra-bony or furcation defects may be amenable to regenerative procedures. This review discusses the regenerative technologies employed for periodontal regeneration, highlighting the current limitations and future research areas. The search, performed on the MEDLINE database, has identified the available biomaterials, including biologicals (autologous platelet concentrates, hydrogels), bone grafts (pure or putty), and membranes. Biologicals and bone grafts have been critically analyzed in terms of composition, mechanism of action, and clinical applications. Although a certain degree of periodontal regeneration is predictable in intra-bony and class II furcation defects, complete defect closure is hardly achieved. Moreover, treating class III furcation defects remains challenging. The key properties required for functional regeneration are discussed, and none of the commercially available biomaterials possess all the ideal characteristics. Therefore, research is needed to promote the advancement of more effective and targeted regenerative therapies for periodontitis. Lastly, improving the design and reporting of clinical studies is suggested by strictly adhering to the Consolidated Standards of Reporting Trials (CONSORT) 2010 statement.
Collapse
Affiliation(s)
- Angela De Lauretis
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”Politecnico di MilanoMilan20133Italy
| | - Øystein Øvrebø
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”Politecnico di MilanoMilan20133Italy
| | - Mario Romandini
- Department of Periodontology, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
| | - Ståle Petter Lyngstadaas
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
| | - Filippo Rossi
- Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”Politecnico di MilanoMilan20133Italy
| | - Håvard Jostein Haugen
- Department of Biomaterials, Institute of Clinical Dentistry, Faculty of DentistryUniversity of OsloOslo0455Norway
| |
Collapse
|
2
|
Cuevas-Gonzalez MV, Cuevas-Gonzalez JC, Espinosa-Cristóbal LF, Donohue-Cornejo A, Reyes López SY, Saucedo Acuña RA, García Calderón AG, Guzmán Gastelum DA. Use or abuse of antibiotics as prophylactic therapy in oral surgery: A systematic review. Medicine (Baltimore) 2023; 102:e35011. [PMID: 37713865 PMCID: PMC10508532 DOI: 10.1097/md.0000000000035011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/08/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUD Antibiotics are a type of medication routinely prescribed by dental professionals; however, it is very common that the administration is not justified. Around 15% of dentists admit that they have administered antibiotics unnecessarily more than once a week. The objective of this project is to identify the effectiveness of the use of antibiotics as prophylactic therapy in oral surgery, and to carry out an analysis of the alternatives to pharmacological therapy. METHODS The search strategy was carried out in the PubMed, Scopus, and ScienceDirect databases. For study selection, a first filter was carried out by title and abstract, which mentioned the use of prophylactic antibiotics in some type of oral surgery. To establish the risk of bias, the JBI Critical Appraisal Checklist for Randomized Controlled Trials was utilized. RESULTS The type of antibiotics most prescribed as prophylactic therapy were beta-lactams, which were indicated in 100% of the studies. Penicillins predominated, observing amoxicillin as the most indicated drug in 54.1% of the studies (n = 13) followed by the use of amoxicillin in conjunction with clavulanic acid in 33.3% of the studies (n = 8). Of the 21 studies included, 17 mention that there is insufficient evidence to support the use of antibiotics as prophylactic therapy in patients who will undergo some type of oral surgery. CONCLUSIONS Without a doubt, the biggest challenge is to develop academic update strategies aimed at dentists with active clinical practice and dental students from educational and government institutions to provide updated information about the correct use of prescription drugs.
Collapse
|
3
|
Matrix Metalloproteinase 9 (MMP-9) and Interleukin-8 (IL-8) in Gingival Crevicular Fluid after Regenerative Therapy in Periodontal Intrabony Defects with and without Systemic Antibiotics-Randomized Clinical Trial. Pathogens 2022; 11:pathogens11101184. [PMID: 36297241 PMCID: PMC9611622 DOI: 10.3390/pathogens11101184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/10/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
The aim of our study was to assess changes in the levels of IL-8 and MMP-9 in gingival crevicular fluid (GCF) collected from the periodontal pocket before and after regenerative surgery with deproteinized bovine bone mineral (DBBM) and collagen membrane (GTR) either independently (DBBM/GTR) or with the postoperative administration of antibiotic (DBBM/GTR+AB). The study involved 41 patients, each with one intrabony defect. IL-8 and MMP-9 were determined before therapy and after 2 weeks, 4 weeks and 6 months following the surgical procedure by means of dedicated ELISA kits. No statistical differences were observed in the levels of IL-8 and MMP-9 after 2 weeks, 4 weeks and 6 months between the groups. The changes in the level of MMP-9 over time were not statistically significant in any group. The changes in the level of IL-8 were significant for the group given antibiotic but not in the nonantibiotic group in the follow-up period. IL-8 and MMP-9 were found to correlate positively but not after 4 weeks in the test group. Current assessment of IL-8 and MMP-9 obtained from GCF samples provides evidence that collagen matrix turnover occurs actively during the early healing phase in the periodontium after regenerative procedures. We observed positive correlations of MMP-9 and IL-8 throughout the study. However, we failed to reveal any differences regard parameters studied between the two groups.
Collapse
|
4
|
Wei YW, Sayed SM, Zhu WW, Xu KF, Wu FG, Xu J, Nie HP, Wang YL, Lu XL, Ma Q. Antibacterial and Fluorescence Staining Properties of an Innovative GTR Membrane Containing 45S5BGs and AIE Molecules In Vitro. NANOMATERIALS 2022; 12:nano12040641. [PMID: 35214970 PMCID: PMC8874606 DOI: 10.3390/nano12040641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 12/04/2022]
Abstract
This study aimed to add two functional components-antibacterial 45S5BGs particles and AIE nanoparticles (TPE-NIM+) with bioprobe characteristics-to the guided tissue regeneration (GTR) membrane, to optimize the performance. The PLGA/BG/TPE-NIM+ membrane was synthesized. The static water contact angle, morphologies, and surface element analysis of the membrane were then characterized. In vitro biocompatibility was tested with MC3T3-E1 cells using CCK-8 assay, and antibacterial property was evaluated with Streptococcus mutans and Porphyromonas gingivalis by the LIVE/DEAD bacterial staining and dilution plating procedure. The fluorescence staining of bacteria was observed by Laser Scanning Confocal Microscope. The results showed that the average water contact angle was 46°. In the cytotoxicity test, except for the positive control group, there was no significant difference among the groups (p > 0.05). The antibacterial effect in the PLGA/BG/TPE-NIM+ group was significantly (p < 0.01), while the sterilization rate was 99.99%, better than that in the PLGA/BG group (98.62%) (p < 0.01). Confocal images showed that the membrane efficiently distinguished G+ bacteria from G- bacteria. This study demonstrated that the PLGA/BG/TPE-NIM+ membrane showed good biocompatibility, efficient sterilization performance, and surface mineralization ability and could be used to detect pathogens in a simple, fast, and wash-free protocol.
Collapse
Affiliation(s)
- Yu-Wen Wei
- Jiangsu Province Key Laboratory of Oral Diseases, Department of General Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing 210029, China; (Y.-W.W.); (W.-W.Z.); (J.X.); (H.-P.N.); (Y.-L.W.)
| | - Sayed Mir Sayed
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, 2 Sipailou Road, Nanjing 210096, China; (S.M.S.); (K.-F.X.); (F.-G.W.)
| | - Wei-Wen Zhu
- Jiangsu Province Key Laboratory of Oral Diseases, Department of General Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing 210029, China; (Y.-W.W.); (W.-W.Z.); (J.X.); (H.-P.N.); (Y.-L.W.)
| | - Ke-Fei Xu
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, 2 Sipailou Road, Nanjing 210096, China; (S.M.S.); (K.-F.X.); (F.-G.W.)
| | - Fu-Gen Wu
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, 2 Sipailou Road, Nanjing 210096, China; (S.M.S.); (K.-F.X.); (F.-G.W.)
| | - Jing Xu
- Jiangsu Province Key Laboratory of Oral Diseases, Department of General Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing 210029, China; (Y.-W.W.); (W.-W.Z.); (J.X.); (H.-P.N.); (Y.-L.W.)
| | - He-Peng Nie
- Jiangsu Province Key Laboratory of Oral Diseases, Department of General Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing 210029, China; (Y.-W.W.); (W.-W.Z.); (J.X.); (H.-P.N.); (Y.-L.W.)
| | - Yu-Li Wang
- Jiangsu Province Key Laboratory of Oral Diseases, Department of General Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing 210029, China; (Y.-W.W.); (W.-W.Z.); (J.X.); (H.-P.N.); (Y.-L.W.)
| | - Xiao-Lin Lu
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, 2 Sipailou Road, Nanjing 210096, China; (S.M.S.); (K.-F.X.); (F.-G.W.)
- Correspondence: (Q.M.); (X.-L.L.); Tel.: +86-13770963117 (Q.M.)
| | - Qian Ma
- Jiangsu Province Key Laboratory of Oral Diseases, Department of General Dentistry, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing 210029, China; (Y.-W.W.); (W.-W.Z.); (J.X.); (H.-P.N.); (Y.-L.W.)
- Correspondence: (Q.M.); (X.-L.L.); Tel.: +86-13770963117 (Q.M.)
| |
Collapse
|
5
|
Abdulkareem A, Abdulbaqi H, Gul S, Milward M, Chasib N, Alhashimi R. Classic vs. Novel Antibacterial Approaches for Eradicating Dental Biofilm as Adjunct to Periodontal Debridement: An Evidence-Based Overview. Antibiotics (Basel) 2021; 11:antibiotics11010009. [PMID: 35052887 PMCID: PMC8773342 DOI: 10.3390/antibiotics11010009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/10/2021] [Accepted: 12/20/2021] [Indexed: 12/14/2022] Open
Abstract
Periodontitis is a multifactorial chronic inflammatory disease that affects tooth-supporting soft/hard tissues of the dentition. The dental plaque biofilm is considered as a primary etiological factor in susceptible patients; however, other factors contribute to progression, such as diabetes and smoking. Current management utilizes mechanical biofilm removal as the gold standard of treatment. Antibacterial agents might be indicated in certain conditions as an adjunct to this mechanical approach. However, in view of the growing concern about bacterial resistance, alternative approaches have been investigated. Currently, a range of antimicrobial agents and protocols have been used in clinical management, but these remain largely non-validated. This review aimed to evaluate the efficacy of adjunctive antibiotic use in periodontal management and to compare them to recently suggested alternatives. Evidence from in vitro, observational and clinical trial studies suggests efficacy in the use of adjunctive antimicrobials in patients with grade C periodontitis of young age or where the associated risk factors are inconsistent with the amount of bone loss present. Meanwhile, alternative approaches such as photodynamic therapy, bacteriophage therapy and probiotics showed limited supportive evidence, and more studies are warranted to validate their efficiency.
Collapse
Affiliation(s)
- Ali Abdulkareem
- College of Dentistry, University of Baghdad, Medical City of Baghdad, Baghdad 10011, Iraq; (H.A.); (N.C.); (R.A.)
- Correspondence:
| | - Hayder Abdulbaqi
- College of Dentistry, University of Baghdad, Medical City of Baghdad, Baghdad 10011, Iraq; (H.A.); (N.C.); (R.A.)
| | - Sarhang Gul
- College of Dentistry, University of Sulaimani, Sulaymaniyah 40062, Iraq;
| | - Mike Milward
- College of Dentistry, University of Birmingham, Birmingham B5 7EG, UK;
| | - Nibras Chasib
- College of Dentistry, University of Baghdad, Medical City of Baghdad, Baghdad 10011, Iraq; (H.A.); (N.C.); (R.A.)
| | - Raghad Alhashimi
- College of Dentistry, University of Baghdad, Medical City of Baghdad, Baghdad 10011, Iraq; (H.A.); (N.C.); (R.A.)
| |
Collapse
|
6
|
Nibali L, Buti J, Barbato L, Cairo F, Graziani F, Jepsen S. Adjunctive Effect of Systemic Antibiotics in Regenerative/Reconstructive Periodontal Surgery-A Systematic Review with Meta-Analysis. Antibiotics (Basel) 2021; 11:antibiotics11010008. [PMID: 35052886 PMCID: PMC8772828 DOI: 10.3390/antibiotics11010008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/27/2022] Open
Abstract
Background and Objective: Systemic antibiotics (AB) are often used in conjunction with regenerative/reconstructive periodontal surgery of intrabony defects and furcations; however, their potential benefits have not been systematically assessed. Materials and Methods: Data were retrieved from two recent systematic reviews (a total of 105 randomized clinical trials (RCTs) on clinical and radiographic outcomes in intrabony defects (ID) and molars with furcation involvement (FI) treated by surgical access with regenerative techniques. Pair-wise meta-analysis of RCTs with and without AB was performed. Meta-regressions from single-arm (subgroup) RCTs including study arms with or without adjunctive AB were also conducted. Results: No statistically significant benefits of systemic AB with regard to PPD, CAL and bone gain were detected in ID by pair-wise meta-analysis. Meta-regression revealed increased PPD reduction (−0.91 mm, 95% CI = −1.30; −0.51, p < 0.001), CAL gain (−0.92 mm, 95% CI = −1.32; −0.52, p < 0.001) and bone gain (−1.08 mm, 95% CI = −1.63; −0.53, p < 0.001) in ID but not in any of the outcomes in FI for arms treated with AB vs. study arms treated with no AB. No clear differences in adverse events were detected between AB and non-AB groups. Conclusion: There is only weak indirect evidence that AB may provide additional benefits in terms of clinical improvements in the regenerative/reconstructive periodontal surgery of intrabony defects and no evidence for a benefit in furcations. Until new data are gained and in the context of antibiotic stewardship, it may be questionable to justify the adjunctive use of systemic antibiotics.
Collapse
Affiliation(s)
- Luigi Nibali
- Periodontology Unit, Centre for Host Microbiome Interactions, King’s College London, London SE1 9RT, UK
- Correspondence:
| | - Jacopo Buti
- Periodontology Department, UCL Eastman Dental Institute, University College London, London WC1E 6BT, UK;
| | - Luigi Barbato
- Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (L.B.); (F.C.)
| | - Francesco Cairo
- Research Unit in Periodontology and Periodontal Medicine, Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (L.B.); (F.C.)
| | - Filippo Graziani
- Unit of Dentistry and Oral Surgery, Department of Surgical, Medical and Molecular Pathology and CriticalCare Medicine, University of Pisa, 56126 Pisa, Italy;
| | - Søren Jepsen
- Department of Periodontology, Operative & Preventive Dentistry, University Hospital Bonn, 53127 Bonn, Germany;
| |
Collapse
|
7
|
Yusri S, Elfana A, Elbattawy W, Fawzy El-Sayed KM. Effect of locally delivered adjunctive antibiotics during surgical periodontal therapy: a systematic review and meta-analysis. Clin Oral Investig 2021; 25:5127-5138. [PMID: 34283285 PMCID: PMC8370941 DOI: 10.1007/s00784-021-04056-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 06/27/2021] [Indexed: 01/08/2023]
Abstract
Aim The present study aimed to systematically assess current evidence on effects of locally delivered antibiotics during periodontal surgery compared to periodontal surgery alone on clinical attachment level (CAL) gain, probing pocket depth (PPD) reduction, recession depth (RD) changes, gingival index (GI), bleeding on probing (BOP), and plaque index (PI). Methodology MEDLINE-PubMed, Cochrane-CENTRAL and Scopus databases were searched up to April 2021 for randomized clinical trials (RCT), evaluating effects of locally delivered antibiotics during periodontal surgery. CAL gain served as primary, while PPD reduction, RD changes, GI and PI as secondary outcomes. The Cochrane Risk of Bias Tool was used to assess possible bias. Data were extracted, and meta-analysis was performed where appropriate. Result Screening of 2314 papers resulted in nine eligible studies. No adverse events were reported. Data on outcome variables were pooled and analyzed using generic inverse variance model and presented as weighted mean difference (WMD) and 95% confidence interval (95% CI). Statistically significant improvements in favor of antibiotics’ delivery were observed in studies with follow-up of ≤6 months for CAL gain (WMD = 0.61 mm (95% CI [0.07, 1.14]; p = 0.03), PPD reduction (WMD = 0.41 mm (95% CI [0.02, 0.80]; p = 0.04)) and BOP (WMD = −28.47% (95% CI [−33.00, −23.94]); p < 0.001), while for GI improvements were notable for >6 to 12 months (WMD = −0.27 (95% CI [−0.49, −0.06]; p = 0.01)). Conclusion Within the current review’s limitations, locally delivered antibiotics during surgical periodontal therapy results in post-surgical improvements for CAL, PPD, and BOP (≤6 months) with a longer-lasting GI improvement. Further randomized controlled trials are needed with true periodontal end-points to assess the ideal antibiotic agent, dosage, and delivery methods. Clinical relevance Local delivery of antibiotics during periodontal surgery improved clinical parameters for up to 6-month follow-up, with beneficial longer effects on gingival inflammation. Within the current study’s limitation, the presented evidence could support the elective usage of locally delivered antibiotics during surgical periodontal therapy. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-021-04056-7.
Collapse
Affiliation(s)
- Sarah Yusri
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Al Saraya Str. 11, Manial, Cairo, Egypt
| | - Ahmed Elfana
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Al Saraya Str. 11, Manial, Cairo, Egypt
| | - Weam Elbattawy
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Al Saraya Str. 11, Manial, Cairo, Egypt
| | - Karim M Fawzy El-Sayed
- Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University, Al Saraya Str. 11, Manial, Cairo, Egypt.
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian Albrechts University, Kiel, Germany.
| |
Collapse
|