Treatment challenges and delivery systems in immunomodulation and probiotic therapies for periodontitis

Can polymeric nanofibers effectively preserve and deliver live therapeutic bacteria?

Probiotics and live therapeutic bacteria (LTB), their strictly regulated therapeutic counterpart, are increasingly important in treating and preventing biofilm-related diseases. This necessitates new approaches to (i) preserve bacterial viability during manufacturing and storage and (ii) incorporate LTB into delivery systems for enhanced therapeutic efficacy. This review explores advances in probiotic and LTB product development, focusing on preservation, protection, and improved delivery. Preservation of bacteria can be achieved by drying methods that decelerate metabolism. These methods introduce stresses affecting viability which can be mitigated with suitable excipients like polymeric or low molecular weight stabilizers. The review emphasizes the incorporation of LTB into polymer-based nanofibers via electrospinning, enabling simultaneous drying, encapsulation, and delivery system production. Optimization of bacterial survival during electrospinning and storage is discussed, as well as controlled LTB release achievable through formulation design using gel-forming, gastroprotective, mucoadhesive, and pH-responsive polymers. Evaluation of the presence of the actual therapeutic strains, bacterial viability and activity by CFU enumeration or alternative analytical techniques is presented as a key aspect of developing effective and safe formulations with LTB. This review offers insights into designing delivery systems, especially polymeric nanofibers, for preservation and delivery of LTB, guiding readers in developing innovative biotherapeutic delivery systems.

Impact of polycaprolactone, alginate, chitosan and zein nanofiber physical properties on immune cells for safe biomedical applications

Nanofiber safety, especially immunogenicity, is important for their successful translation to clinical setting. This study provides a comprehensive evaluation of how nanofiber physical properties influence immune cells cultured on them, specifically peripheral blood mononuclear cells (PBMCs). We prepared nanofibers with a wide range of physical properties including various diameters, interfibrillar pore sizes and mat thicknesses, using four main polymers: polycaprolactone, alginate, chitosan, and zein. Our findings show that nanofiber diameters had only a marginal influence on the activity of immune cells, whereas interfibrillar nanofiber pore sizes had a significant effect, and mat thickness proved to have the greatest impact. Cells that penetrated deeper into the thick nanofiber mats ceased to proliferate but did not experience cytotoxicity. Moreover, we discovered that PBMCs penetrating the zein/PVP nanofiber mesh exhibited increased metabolic activity, indicating potential immunogenicity, whereas the other tested non-immunogenic nanofibers reduced it. To best of our knowledge, this study is the first to report on the impact of various nanofiber physical properties on in vitro immune cell behavior, thereby expanding the knowledge in the relatively unexplored field of nanofiber immunological safety. It underscores the need for rigorous preclinical nanofiber assessment and setting new standards for designing nanofiber-based biomedical products.

Probiotics in the non-surgical treatment of periodontitis: a systematic review and network meta-analysis

This systematic review and network meta-analysis aimed to assess the impact of combining professional mechanical plaque removal (PMPR) with probiotics compared to PMPR + placebo on probing pocket depth (PPD) and clinical attachment level (CAL). Randomized controlled trials published until November 2023 were searched across electronic databases, peer-reviewed journals, and grey literature. Two authors independently selected, extracted data, and assessed bias risk. Primary outcomes were mean changes in PPD and CAL. Secondary outcomes included mean changes in bleeding on probing (BOP), plaque index, and colony-forming units. Network meta-analysis with the frequentist weighted least squares approach evaluated the data quantitatively, and CINeMA framework evaluated the quality of evidence. In 33 articles involving 1290 patients, results were stratified by follow-up period (short and long-time studies) and sensitivity analyses conducted based on probiotic therapy duration (1 month reference). Network meta-analysis revealed significant mean differences in PPD for nine probiotic interventions, CAL for eighteen interventions, and BOP for eight interventions, with Lactobacillus demonstrating the most substantial effects. Combining PMPR with probiotics as adjuvants to subgingival instrumentation may be more effective in improving PPD and CAL. Lactobacillus emerged as the most comprehensive and effective among the studied probiotic.

Bacillus altitudinis 1.4 genome analysis-functional annotation of probiotic properties and immunomodulatory activity

Probiotics are live microorganisms that, when administered in adequate quantities, provide health benefits to the host. In this study, phenotypic and genotypic methods were used to evaluate the probiotic properties of Bacillus altitudinis 1.4. The isolate was sensitive to all antimicrobials tested and presented a positive result in the hemolysis test. B. altitudinis 1.4 spores were more resistant than vegetative cells, when evaluated in simulation of cell viability in the gastrointestinal tract, as well as adhesion to the intestinal mucosa. The isolate was capable of self-aggregation and coaggregation with pathogens such as Escherichia coli ATCC 25922 and Salmonella Enteritidis ATCC 13076. Genomic analysis revealed the presence of genes with probiotic characteristics. From this study it was possible to evaluate the gene expression of pro-inflammatory and anti-inflammatory cytokines for different treatments. Viable vegetative cells of B. altitudinis 1.4 increased the transcription of pro-inflammatory factors, in addition to also increasing the transcription of IL-10, indicating a tendency to stimulate a pro-inflammatory profile. Given the results presented, B. altitudinis 1.4 showed potential to be applied in the incorporation of this microorganism into animal feed, since the spores could tolerate the feed handling and pelletization processes.

Anticancer Potential of Postbiotic Derived from Lactobacillus brevis and Lactobacillus casei: In vitro Analysis of Breast Cancer Cell Line

Breast cancer has emerged as the most widespread and dangerous type of malignancy among women worldwide. Postbiotics have recently emerged as a promising novel adjunct in breast cancer therapy, due to their immunomodulatory effects and the potential to mitigate the adverse effects of conventional treatments. This study aims to investigate the therapeutic effects of postbiotics derived from Lactobacillus brevis (CSF2) and Lactobacillus casei (CFS5), specifically examining their ability to inhibit cell proliferation and induce apoptosis in MCF-7 breast cancer cells. In the current study, the anticancer activity of the cell-free supernatant of L. brevis and L. casei was investigated against MCF-7 cells using MTT assay, flow cytometry, and qRT-PCR technique. Both bacteria showed a high potential for the induction of cell death in MCF-7 cells. However, CFS2 cytotoxicity was significantly higher than CFS5. Flow cytometry results showed significant induction of early apoptosis in cells treated with both CFS2 and CFS5 within 48 h. The induction was notably higher in cells treated with CFS2 compared to CFS5. Overall, CFS2 therapy resulted in a greater increase in BAX and CASP9 gene expression, as well as an elevated BAX/BCL2 ratio within 48 h. These findings indicate that the CFS2 treatment showed a higher level of apoptotic activity than the CFS5 treatment. High biocompatibility was demonstrated following treatment with CFS2 and CFS5. These CFSs may serve as adjunctive medications for suppressing the proliferation of cancer cells. The results of the current study highlight the potential of postbiotics in cancer treatment and suggest that supernatants may serve as effective agents for suppressing cancer cell growth and viability.

Assessment of the Effect on Periodontitis of Antibiotic Therapy and Bacterial Lysate Treatment

Periodontitis is an inflammatory process that starts with soft tissue inflammation caused by the intervention of oral bacteria. By modulating local immunity, it is possible to supplement or replace current therapeutic methods. The aim of this study was to compare the effects of an immunostimulatory treatment with the antibiotherapy usually applied to periodontitis patients. On a model of periodontitis induced in 30 rats (divided into three equal groups) with bacterial strains selected from the human oral microbiome (Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum and Streptococcus oralis), we administered antibiotics, bacterial lysates and saline for 10 days. Clinically, no significant lesions were observed between the groups, but hematologically, we detected a decrease in lymphocyte and neutrophil counts in both the antibiotic and lysate-treated groups. Immunologically, IL-6 remained elevated compared to the saline group, denoting the body's effort to compensate for bone loss due to bacterial action. Histopathologically, the results show more pronounced oral tissue regeneration in the antibiotic group and a reduced inflammatory reaction in the lysate group. We can conclude that the proposed bacterial lysate has similar effects to antibiotic therapy and can be considered an option in treating periodontitis, thus eliminating the unnecessary use of antibiotics.

The role of probiotic therapy on clinical parameters and human immune response in peri-implant diseases: a systematic review and meta-analysis of randomized clinical studies

Background

Peri-implant diseases (peri-implant mucositis and peri-implantitis) are pathologies of an infectious-inflammatory nature of the mucosa around dental implants. Probiotics are microorganisms that regulate host immunomodulation and have shown positive results in the treatment of peri-implant diseases. The objective of the systematic review and meta-analysis was to evaluate the efficacy of probiotics in the treatment of peri-implant oral diseases.

Methods

According to the PRISMA guidelines, the research question was established: Are probiotics able to favorably modify clinical and immunological biomarkers determinants of peri-implant pathologies? and an electronic search of the databases MEDLINE/PubMed, Embase, Cochrane Central, Web of Science, (until December 2023) was performed. Inclusion criteria were established for intervention studies (RCTs), according to the PICOs strategy in subjects with peri-implant pathology (participants), treated with probiotics (intervention) compared to patients with conventional treatment or placebo (control) and evaluating the response to treatment (outcomes). Results- 1723 studies were obtained and 10 were selected. Risk of bias was assessed using the Cochrane Risk of Bias Tool and methodological quality using the Joanna Briggs Institute for RCTs. Two meta-analyses were performed, one to evaluate probiotics in mucositis and one for peri-implantitis. All subgroups were homogeneous (I2 = 0%), except in the analysis of IL-6 in mucositis (I2 = 65%). The overall effect was favorable to the experimental group in both pathologies. The analysis of the studies grouped in peri-implantitis showed a tendency to significance (p=0.09).

Conclusion

The use of probiotics, as basic or complementary treatment of peri-implant diseases, showed a statistically significant trend, but well-designed studies are warranted to validate the efficacy of these products in peri-implant pathologies.

New insights into nanotherapeutics for periodontitis: a triple concerto of antimicrobial activity, immunomodulation and periodontium regeneration

Periodontitis is a chronic inflammatory disease caused by the local microbiome and the host immune response, resulting in periodontal structure damage and even tooth loss. Scaling and root planning combined with antibiotics are the conventional means of nonsurgical treatment of periodontitis, but they are insufficient to fully heal periodontitis due to intractable bacterial attachment and drug resistance. Novel and effective therapeutic options in clinical drug therapy remain scarce. Nanotherapeutics achieve stable cell targeting, oral retention and smart release by great flexibility in changing the chemical composition or physical characteristics of nanoparticles. Meanwhile, the protectiveness and high surface area to volume ratio of nanoparticles enable high drug loading, ensuring a remarkable therapeutic efficacy. Currently, the combination of advanced nanoparticles and novel therapeutic strategies is the most active research area in periodontitis treatment. In this review, we first introduce the pathogenesis of periodontitis, and then summarize the state-of-the-art nanotherapeutic strategies based on the triple concerto of antibacterial activity, immunomodulation and periodontium regeneration, particularly focusing on the therapeutic mechanism and ingenious design of nanomedicines. Finally, the challenges and prospects of nano therapy for periodontitis are discussed from the perspective of current treatment problems and future development trends.

Potential targets of phytochemical immunomodulatory therapy in periodontitis immunopathogenesis: A narrative review

Introduction

Periodontitis is one of the most prevalent diseases occurring worldwide, and is caused by an imbalance of host immunological defenses and microbiome profile which occurs in the oral cavity. This imbalance leads to irregularity and uncontrolled activities of immune cells, resulting in over-reactivity of periodontopathogens and tissue destruction. To alleviate periodontitis, exact targeting of specific events involving particular cells could be a potential application of immunomodulatory agents. Phytochemical drug development targeting specific immunopathogenesis events could be a promising complementary, alternative approach to periodontal therapy.

Objectives

This review aimed to explore various events involving a variety of cells in the immunopathogenesis of periodontitis in order to determine potential specific immunomodulation targets for future development of effective phytochemical drugs.

Results

Immunopathogenesis of periodontitis contributes significantly to the disease onset and resolution. Various events occur during the disease development, which involve a variety of immune cells and mediators. Among these, neutrophils, cytokines and lymphocytes, especially Th17 cells, were reported to be the most relevant components in the disease pathogenesis. These components affect the initial responses to periodontopathogens, inhibit oxidative stress formation, control intercellular communication to enhance inflammation, and promote effector cells' migration to induce alveolar bone resorption. Several phytochemical drugs were developed to cure periodontitis, however, the development of phytochemical immunomodulatory drugs to target specific events has not been realized.

Conclusion

This review concluded that development of phytochemical immunomodulatory drugs to target particular events generated by neutrophils, pro-inflammatory cytokines and lymphocytes has tremendous potential to regulate and modulate the immunopathogenesis of periodontitis.

CCL2 is a key regulator and therapeutic target for periodontitis

AIM

Our previous study revealed that the C-C motif chemokine receptor 2 (CCR2) is a promising target for periodontitis prevention and treatment. However, CCR2 is a receptor with multiple C-C motif chemokine ligands (CCLs), including CCL2, CCL7, CCL8, CCL13 and CCL16, and which of these ligands plays a key role in periodontitis remains unclear. The aim of the present study was to explore the key functional ligand of CCR2 in periodontitis and to evaluate the potential of the functional ligand as a therapeutic target for periodontitis.

MATERIALS AND METHODS

The expression levels and clinical relevance of CCR2, CCL2, CCL7, CCL8, CCL13 and CCL16 were studied using human samples. The role of CCL2 in periodontitis was evaluated by using CCL2 knockout mice and overexpressing CCL2 in the periodontium. The effect of local administration of bindarit in periodontitis was evaluated by preventive and therapeutic medication in a mouse periodontitis model. Microcomputed tomography, haematoxylin and eosin staining, tartrate-resistant acid phosphatase staining, real-time quantitative polymerase chain reaction, enzyme-linked immunosorbent assay, bead-based immunoassays and flow cytometry were used for histomorphology, molecular biology and cytology analysis.

RESULTS

Among different ligands of CCR2, only CCL2 was significantly up-regulated in periodontitis gingival tissues and was positively correlated with the severity of periodontitis. Mice lacking CCL2 showed milder inflammation and less bone resorption than wild-type mice, which was accompanied by a reduction in monocyte/macrophage recruitment. Adeno-associated virus-2 vectors overexpressing CCL2 in Ccl2-/- mice gingiva reversed the attenuation of periodontitis in a CCR2-dependent manner. In ligation-induced experimental periodontitis, preventive or therapeutic administration of bindarit, a CCL2 synthesis inhibitor, significantly inhibited the production of CCL2, decreased the osteoclast number and bone loss and reduced the expression levels of proinflammatory cytokines TNF-α, IL-6 and IL-1β.

CONCLUSIONS

CCL2 is a pivotal chemokine that binds to CCR2 during the progression of periodontitis, and targeting CCL2 may be a feasible option for controlling periodontitis.

Impact of local drug delivery and natural agents as new target strategies against periodontitis: new challenges for personalized therapeutic approach

Periodontitis is a persistent inflammation of the soft tissue around the teeth that affects 60% of the population in the globe. The self-maintenance of the inflammatory process can cause periodontal damage from the alveolar bone resorption to tooth loss in order to contrast the effects of periodontitis, the main therapy used is scaling and root planing (SRP). At the same time, studying the physiopathology of periodontitis has shown the possibility of using a local drug delivery system as an adjunctive therapy. Using local drug delivery devices in conjunction with SRP therapy for periodontitis is a potential tool since it increases drug efficacy and minimizes negative effects by managing drug release. This review emphasized how the use of local drug delivery agents and natural agents could be promising adjuvants for the treatment of periodontitis patients affected or not by cardiovascular disease, diabetes, and other system problems. Moreover, the review evidences the current issues and new ideas that can inspire potential later study for both basic research and clinical practice for a tailored approach.

Development of Nanofibers with Embedded Liposomes Containing an Immunomodulatory Drug Using Green Electrospinning

Conventional treatments for chronic wounds are often ineffective, thus new therapeutic approaches are needed, such as the delivery of immunomodulatory drugs that can reduce inflammation, restore immune cell function, and facilitate tissue regeneration. A potential drug for such an approach is simvastatin, which has major drawbacks including poor solubility and chemical instability. With the aim of developing a dressing for wound healing, simvastatin and an antioxidant were incorporated into alginate/poly(ethylene oxide) nanofibers by green electrospinning without the use of organic solvents, thanks to their prior encapsulation into liposomes. The composite liposome-nanofiber formulations exhibited fibrillar morphology (160-312 nm) and unprecedentedly high phospholipid and drug content (76%). Transmission electron microscopy revealed dried liposomes as bright ellipsoidal spots homogeneously distributed over the nanofibers. After nanofiber hydration, the liposomes reconstituted in two size populations (~140 and ~435 nm), as revealed by cutting-edge MADLS^® analysis. Lastly, in vitro assays demonstrated that composite liposome-nanofiber formulations are superior to liposomal formulations due to a better safety profile in keratinocytes and peripheral blood mononuclear cells. Furthermore, both formulations exhibited similarly advantageous immunomodulatory effects, measured as decreased inflammation in vitro. A synergistic combination of the two nanodelivery systems shows promise for the development of efficient dressings for chronic wound treatment.

Nanomaterials: an intra-periodontal pocket drug-delivery system for periodontitis

Periodontitis is a microbiological condition that affects the tissues supporting the teeth. The fundamental to effective periodontal therapy is choosing the suitable antimicrobial and anti-inflammatory agent, together with the proper route of drug administration and delivery system. Intra-periodontal pocket approach with nano drug-delivery systems (NDDS) such as polymeric nanoparticles, gold nanoparticles, silica nanoparticles, magnetic nanoparticles, liposomes, polymersomes, exosomes, nano micelles, niosome, solid lipid nanoparticles, nano lipid carriers, nanocomposites, nanogels, nanofibers, scaffolds, dendrimers, quantum dots, etc., will be appropriate route of drug administration and delivery system. This NDDS delivers the drugs at the site of infection to inhibit growth and promote tissue regeneration. The present review focused on providing comprehensive information on the NDDS for periodontitis, which enhanced therapeutic outcomes via intra-periodontal pocket delivery.

Nanofibers with genotyped Bacillus strains exhibiting antibacterial and immunomodulatory activity

Biofilm-associated diseases such as periodontitis are widespread and challenging to treat which calls for new strategies for their effective management. Probiotics represent a promising approach for targeted treatment of dysbiosis in biofilm and modulation of host immune response. In this interdisciplinary study, nanofibers with two autochthonous Bacillus strains 27.3.Z and 25.2.M were developed. The strains were isolated from the oral microbiota of healthy individuals, and their genomes were sequenced and screened for genes associated with antimicrobial and immunomodulatory activities, virulence factors, and transferability of resistance to antibiotics. Spores of two Bacillus strains were incorporated individually or in combination into hydrophilic poly(ethylene oxide) (PEO) and composite PEO/alginate nanofibers. The nanofiber mats were characterised by a high loading of viable spores (> 7 log CFU/mg) and they maintained viability during electrospinning and 6 months of storage at room temperature. Spores were rapidly released from PEO nanofibers, while presence of alginate in the nanofibers prolonged their release. All formulations exhibited swelling, followed by transformation of the nanofiber mat into a hydrogel and polymer erosion mediating spore release kinetics. The investigated Bacillus strains released metabolites, which were not cytotoxic to peripheral blood mononuclear cells (PBMCs) in vitro. Moreover, their metabolites exhibited antibacterial activity against two periodontopathogens, an antiproliferative effect on PBMCs, and inhibition of PBMC expression of proinflammatory cytokines. In summary, the developed nanofiber-based delivery system represents a promising therapeutic approach to combat biofilm-associated disease on two fronts, namely via modulation of the local microbiota with probiotic bacteria and host immune response with their metabolites.

Advances in novel therapeutic approaches for periodontal diseases

Periodontal diseases are pathological processes resulting from infections and inflammation affecting the periodontium or the tissue surrounding and supporting the teeth. Pathogenic bacteria living in complex biofilms initiate and perpetuate this disease in susceptible hosts. In some cases, broad-spectrum antibiotic therapy has been a treatment of choice to control bacterial infection. However, increasing antibiotic resistance among periodontal pathogens has become a significant challenge when treating periodontal diseases. Thanks to the improved understanding of the pathogenesis of periodontal disease, which involves the host immune response, and the importance of the human microbiome, the primary goal of periodontal therapy has shifted, in recent years, to the restoration of homeostasis in oral microbiota and its harmonious balance with the host periodontal tissues. This shift in therapeutic goals and the drug resistance challenge call for alternative approaches to antibiotic therapy that indiscriminately eliminate harmful or beneficial bacteria. In this review, we summarize the recent advancement of alternative methods and new compounds that offer promising potential for the treatment and prevention of periodontal disease. Agents that target biofilm formation, bacterial quorum-sensing systems and other virulence factors have been reviewed. New and exciting microbiome approaches, such as oral microbiota replacement therapy and probiotic therapy for periodontal disease, are also discussed.

Disinfection Potential of 980 nm Diode Laser and Hydrogen Peroxide (3%) in "Critical Probing Depths" Periodontal Pockets: Retrospective Study

A successful treatment of periodontitis depends largely on the successful elimination of the periodontopathogens during non-surgical and surgical mechanical debridement. In this retrospective study, data collection was conducted from 2017 to 2021. The retrospective study included 128 patients with 128 sites of localized periodontitis with pocket depths > 5 mm. The included data were based on sites that received conventional mechanical debridement followed by different adjunctive approaches. In total, 30 patients did not receive any additional treatment (SRP group), 30 patients received SRP + 980 nm diode laser irradiation only (SRP + laser), 30 patients received SRP + 3% hydrogen peroxide irrigation (SRP + H2O2) only and 30 patients received a combined treatment of 3% hydrogen peroxide and 980 nm diode laser irradiation (SRP + H2O2 + laser). Total bacterial counts (TBC) in the periodontal pocket collected for all participants before treatment, immediately after treatment, 6 weeks after treatment, 12 weeks after treatment and 6 months after treatment were statistically analyzed and compared. When the laser was used, irradiation parameters were 10 μsec/pulse duration, 10 kHz, pick power of 10 W, average power of 1 W, irradiation time of one minute with inward and outward movements, and fiber diameter of 320 μm. The irradiation was repeated 3 times/pocket. When hydrogen peroxide was used, the irrigation was conducted for one minute and repeated 3 times. The maximum reduction in TBC was obtained when SRP was coupled with 3% H2O2 irrigation followed by 980 nm diode laser irradiation. After six months of follow-up, a significant reduction in TBC was obtained for the group of SRP + H2O2 + laser when compared to all the other groups, from 7.27 × 107 before intervention to 3.21 × 107 after six months. All three approaches to SRP showed a significant reduction in TBC immediately after treatment. Values were 3.52 × 107, 4.01 × 106, 9.58 × 106, 1.98 × 106 for SRP alone, SRP + diode, SRP + H2O2 and SRP + H2O2 + diode laser, respectively. At 6 months, we saw no significant difference between SRP + laser and SRP + H2O2 with 4.01 × 107 and 4.32 × 107, respectively. This retrospective study reveals that after SRP, irrigation with 3% hydrogen peroxide and irradiation with a 980 nm diode laser within specific treatment protocol can be used as an additional approach to conventional SRP to increase the disinfection of the periodontal pockets > 5 mm.

C3-targeted host-modulation approaches to oral inflammatory conditions

Periodontitis is an inflammatory disease caused by biofilm accumulation and dysbiosis in subgingival areas surrounding the teeth. If not properly treated, this oral disease may result in tooth loss and consequently poor esthetics, deteriorated masticatory function and compromised quality of life. Epidemiological and clinical intervention studies indicate that periodontitis can potentially aggravate systemic diseases, such as, cardiovascular disease, type 2 diabetes mellitus, rheumatoid arthritis, and Alzheimer disease. Therefore, improvements in the treatment of periodontal disease may benefit not only oral health but also systemic health. The complement system is an ancient host defense system that plays pivotal roles in immunosurveillance and tissue homeostasis. However, complement has unwanted consequences if not controlled appropriately or excessively activated. Complement overactivation has been observed in patients with periodontitis and in animal models of periodontitis and drives periodontal inflammation and tissue destruction. This review places emphasis on a promising periodontal host-modulation therapy targeting the complement system, namely the complement C3-targeting drug, AMY-101. AMY-101 has shown safety and efficacy in reducing gingival inflammation in a recent Phase 2a clinical study. We also discuss the potential of AMY-101 to treat peri-implant inflammatory conditions, where complement also seems to be involved and there is an urgent unmet need for effective treatment.

Immunomodulation in the Treatment of Periodontitis: Progress and Perspectives

Periodontitis is one of the most common dental diseases. Compared with healthy periodontal tissues, the immune microenvironment plays the key role in periodontitis by allowing the invasion of pathogens. It is possible that modulating the immune microenvironment can supplement traditional treatments and may even promote periodontal regeneration by using stem cells, bacteria, etc. New anti-inflammatory therapies can enhance the generation of a viable local immune microenvironment and promote cell homing and tissue formation, thereby achieving higher levels of immune regulation and tissue repair. We screened recent studies to summarize the advances of the immunomodulatory treatments for periodontitis in the aspects of drug therapy, microbial therapy, stem cell therapy, gene therapy and other therapies. In addition, we included the changes of immune cells and cytokines in the immune microenvironment of periodontitis in the section of drug therapy so as to make it clearer how the treatments took effects accordingly. In the future, more research needs to be done to improve immunotherapy methods and understand the risks and long-term efficacy of these methods in periodontitis.