New Frontiers on Adjuvants Drug Strategies and Treatments in Periodontitis

Review of carbonaceous nanoparticles for antibacterial uses in various dental infections

The mouth cavity is the second most complex microbial community in the human body. It is composed of bacteria, viruses, fungi, and protozoa. An imbalance in the oral microbiota may lead to various conditions, including caries, soft tissue infections, periodontitis, root canal infections, peri-implantitis (PI), pulpitis, candidiasis, and denture stomatitis. Additionally, several locally administered antimicrobials have been suggested for dentistry in surgical and non-surgical applications. The main drawbacks are increased antimicrobial resistance, the risk of upsetting the natural microbiota, and hypersensitivity responses. Because of their unique physiochemical characteristics, nanoparticles (NPs) can circumvent antibiotic-resistance mechanisms and exert antimicrobial action via a variety of new bactericidal routes. Because of their anti-microbial properties, carbon-based NPs are becoming more and more effective antibacterial agents. Periodontitis, mouth infections, PI, dentin and root infections, and other dental diseases are among the conditions that may be treated using carbon NPs (CNPs) like graphene oxide and carbon dots. An outline of the scientific development of multifunctional CNPs concerning oral disorders will be given before talking about the significant influence of CNPs on dental health. Some of these illnesses include Periodontitis, oral infections, dental caries, dental pulp disorders, dentin and dental root infections, and PI. We also review the remaining research and application barriers for carbon-based NPs and possible future problems.

Doxycycline-Loaded pH-Sensitive Microparticles as a Potential Site-Specific Drug Delivery System against Periodontitis

A significant obstacle to the healing process of periodontitis is the development of bacterial biofilms within the periodontal pockets. The efficacy of bacterial biofilm therapy is often hindered by the inadequate penetration of antibacterial agents and the nonspecific targeting of bacteria. This study proposes a novel strategy involving the utilization of pH-sensitive microparticles (MPs) of doxycycline (DOX) to enhance biofilm penetration and enable targeted delivery of DOX to infection sites associated with periodontitis. The MPs were developed using a double-emulsion technique with poly(d,l-lactide-co-glycolide) and chitosan in a 1:1 ratio. The morphology of DOX-MP exhibits a spherical form with a particle size of 3.54 ± 0.32 μm and a PDI of 0.221 ± 0.02. The DOX-MP also had great encapsulation efficiency (69.43% ± 5.32) and drug loading efficiency (14.81% ± 1.32) with regulated drug release kinetics and accelerated release rates under low-pH conditions. The antimicrobial activity was evaluated against Escherichia coli and Staphylococcus aureus, and the results indicated the absence of any viable bacterial colonies after 18 h at twice the minimum inhibitory concentration value. Hydrogel-based MPs deliver DOX to the periodontal pocket infection site for ease of use. In situ hydrogels used Pluronic F127 and F68 as the main polymer composition and hydroxypropyl methylcellulose as the adhesion polymer. This formulation exhibited a liquid state at room temperature (25 °C) but went through gelation at 36 °C. The formulation also had good mucoadhesive characteristics (42.65 ± 3.53 dyn/cm2) and good drug permeation at acidic pH in Mueller-Hinton Broth media with the addition of E. coli and S. aureus bacteria. Ex vivo antibacterial activity significantly reduced the microbial count, biofilm quantity, and metabolic activity, confirming the desired antibacterial effect. Hence, the utilization of free drugs and DOX-MPs did not exhibit a notable dissimilarity, showing that integrating the drug into the matrix was not hindering its antibacterial efficacy.

Clinical and Microbiological Effectiveness of Diode Laser for Treating Patients with Stage II Grade A Periodontitis Patients: Split-Mouth Study

Objectives: This split-mouth randomized controlled clinical trial aimed to evaluate the efficacy of diode laser therapy as an adjunct to scaling and root planning (SRP) in the management of patients with stage II grade A periodontitis. Methods: Thirty participants were randomly assigned to receive either SRP alone (control group) or SRP and diode laser application (study group) on the contralateral side. Clinical parameters (plaque index, gingival index, probing depth, and clinical attachment level) and microbiological markers; Aggregatibacter actinomycetemcomitans (A actinomycetemcomitans), Porphyromonas gingivalis (P gingivalis), and Fusobacterium nucleatum (F nucleatum) were evaluated at baseline and at 4, 8, and 12 weeks post-treatment. Results: Both groups reported significant improvements in all clinical parameters over the follow-up period. The study group reported a significantly higher reduction in probing depth at 12 weeks than the SRP-alone group. Microbiological evaluation revealed significantly greater reductions in P gingivalis and F. nucleatum levels in the study group at later time points, whereas no significant alterations were observed for A actinomycetemcomitans. Conclusions: Our results suggest that the adjunctive use of diode laser therapy may improve the clinical and microbiological findings of nonsurgical periodontal management in patients with stage II grade A periodontitis.

In Vitro Release Dynamics of Atorvastatin-Loaded Alginate Particles for Enhanced Periodontal Treatment

Periodontitis is a chronic inflammatory condition of the periodontium, which often leads to tooth loss. Recently, statins have emerged as potent anti-inflammatory agents with pleiotropic effects that can potentially outperform conventional periodontal treatments. However, the clinical application of statins is limited by the lack of suitable drug carriers that fit the periodontal region and provide a controlled local drug release. In this study, we address the critical gap in localized periodontal drug delivery and introduce an ultrasound-assisted technique to encapsulate atorvastatin within alginate microparticles (10-400 µm in diameter)-a simple, scalable, and biocompatible solution. While ultrasound is widely used in polymer synthesis, its application in alginate polymerization remains underexplored. To mimic physiological conditions, particles were incubated in artificial saliva at 37 °C, with drug release being analyzed via high-performance liquid chromatography. A methylcellulose-based hydrogel served as a conventional reference product. Results revealed that alginate particles exhibited at least a 10-fold increase in mean dissolution time compared to the methylcellulose gel, indicating superior stability. Increasing atorvastatin concentration extended the time interval needed for 50% of the drug to be released (t50%) from 1 h to 11 h, maintaining the overall drug diffusion level for several days. Further analysis showed that covalent cross-linking of alginate with divinyl sulfone significantly delayed the initial drug release by 3 h (p < 0.05) due to the additional molecular stabilization. These findings underscore the utility of ultrasonic atomization for the processing of alginate-based formulations. Given the ease of production, biocompatibility, and small size, successfully fabricated alginate particles represent a promising carrier for delivery of statins or other related drugs in clinical dentistry.

Enhancing periodontal defences with nanofiber treatment: recent advances and future prospects

The term periodontal disease is used to define diseases characterised by inflammation and regeneration of the gums, cementum, supporting bone, and periodontal ligament. The conventional treatment involves the combination of scaling, root planning, and surgical approaches which are invasive and can pose certain challenges. Intrapocket administration of nanofibers can be used for overcoming challenges which can help in speeding up the wound repair process and can also be used to promote osteogenesis. To help make drug delivery more effective, nanofibers are an interesting solution. Nanofibers are nanosized 3D structures that can fill the pockets and have excellent mucoadhesion which prolongs their retention time on the target site. Moreover, their structure mimics the natural extracellular matrix which enables nanomaterials to sense local biological conditions and start cellular-level reprogramming to produce the necessary therapeutic efficacy. In this review, the significance of intrapocket administration of nanofibers using recent research for the management of periodontitis has been discussed in detail. Furthermore, we have discussed polymers used for the preparation of nanofibers, nanofiber production methods, and the patents associated with these developments. This comprehensive compilation of data serves as a valuable resource, consolidating recent developments in nanofiber applications for periodontitis management into one accessible platform.

Exploring the Efficacy of Novel Therapeutic Strategies for Periodontitis: A Literature Review

Periodontitis, a prevalent oral condition, is facing difficulties in therapeutic approaches, sometimes leading to failure. This literature review was conducted to investigate the diversity of other therapeutic approaches and their potential contributions to the successful management of the disease. This research scrutinized the alterations in microbial diversity and imbalances in crucial microbial species, which contribute significantly to the pathogenesis of periodontitis. Within the limitations of this study, we highlight the importance of understanding the treatment plan's role in periodontitis disease, opening the way for further research and innovative treatment plans to mitigate the impact of periodontitis on oral health. This will aid both healthcare professionals and patients in preventing and effectively treating periodontitis, ultimately improving oral health outcomes and overall systemic health and well-being.

QbD-Assisted Development and Optimization of Doxycycline Hyclate- and Hydroxyapatite-Loaded Nanoparticles for Periodontal Delivery

The current research aims to develop a carrier system for the delivery of a matrix metalloproteinase (MMP) inhibitor along with a bioceramic agent to the periodontal pocket. It is proposed that the present system, if given along with a systemic antibiotic, would be a fruitful approach for periodontitis amelioration. To fulfill the aforementioned objective, a doxycycline hyclate- and hydroxyapatite-adsorbed composite was prepared by a physical adsorption method and successfully loaded inside sodium alginate-chitosan nanoparticles and optimized based on particle size and drug content. Optimized formulation was then subjected to different evaluation parameters like encapsulation efficiency, hydroxyapatite content, ζ potential, surface morphology, in vitro drug release, cell line studies, and stability studies. For the optimized formulation, particle size, polydispersity index (PDI), entrapment efficiency, ζ potential, and drug content were found to be 336.50 nm, 0.23, 41.77%, -13.85 mV, and 14.00%, respectively. The surface morphology of the placebo and adsorbed composite-loaded nanoparticles as observed by scanning electron microscopy (SEM) and transmission electron microscopy (TEM) revealed the spherical shape and rough surface of the particles. In gingival crevicular fluid (GCF) 7.6, a sustained drug release profile was obtained up to 36 h. In vitro % viability studies performed on murine fibroblast cells (NIH3T3) and human periodontal ligament (hPDL) cell lines confirmed the proliferative nature of the formulation. Also, when subjected to stability studies for 4 weeks, particle size, PDI, and drug content did not vary considerably, thereby ensuring the stable nature of nanoparticles. Henceforth, sodium alginate-chitosan nanoparticles appeared to be a good carrier system for doxycycline hyclate and hydroxyapatite for periodontal therapy. If given along with a system antibiotic, the system will serve as a fruitful tool for infection-mediated periodontal regeneration and healing.

A Local Desiccant Antimicrobial Agent as an Alternative to Adjunctive Antibiotics in the Treatment of Periodontitis: A Narrative Review

Periodontitis is one of the most common oral polymicrobial infectious diseases induced by the complex interplay between the altered subgingival microbiota and the host’s dysregulated immune-inflammatory response, leading to the initiation of progressive and irreversible destruction of the periodontal tissues and eventually to tooth loss. The main goal of cause-related periodontal therapy is to eliminate the dysbiotic subgingival biofilm in order to arrest local inflammation and further periodontal tissue breakdown. Because, in some cases, subgingival mechanical instrumentation has limited efficiency in achieving those goals, various adjunctive therapies, mainly systemic and locally delivered antimicrobials, have been proposed to augment its effectiveness. However, most adjunctive antimicrobials carry side effects; therefore, their administration should be precociously considered. HybenX® (HY) is a commercial therapeutical agent with decontamination properties, which has been studied for its effects in treating various oral pathological conditions, including periodontitis. This review covers the current evidence regarding the treatment outcomes and limitations of conventional periodontal therapies and provides information based on the available experimental and clinical studies related to the HY mechanism of action and effects following its use associated with subgingival instrumentation and other types of dental treatments.

A Systematic Review and Meta-Analysis on the Efficacy of Locally Delivered Adjunctive Curcumin (Curcuma longa L.) in the Treatment of Periodontitis

This meta-analysis intended to assess evidence on the efficacy of locally delivered curcumin/turmeric as an adjunctive to scaling and root planing (SRP), on clinical attachment level (CAL) and probing pocket depth (PPD), compared to SRP alone or in combination with chlorhexidine (CHX). RCTs were identified from PubMed, Cochrane Library, BASE, LIVIVO, Dentistry Oral Sciences Source, MEDLINE Complete, Scopus, ClinicalTrials.gov, and eLibrary, until August 2022. The risk of bias (RoB) was assessed with the Cochrane Risk of Bias tool 2.0. A random-effects meta-analysis was performed by pooling mean differences with 95% confidence intervals. Out of 827 references yielded by the search, 23 trials meeting the eligibility criteria were included. The meta-analysis revealed that SRP and curcumin/turmeric application were statistically significantly different compared to SRP alone for CAL (-0.33 mm; p = 0.03; 95% CI -0.54 to -0.11; I2 = 62.3%), and for PPD (-0.47 mm; p = 0.024; 95% CI -0.88 to -0.06; I2 = 95.5%); however, this difference was considered clinically meaningless. No significant differences were obtained between patients treated with SRP and CHX, compared to SRP and curcumin/turmeric. The RoB assessment revealed numerous inaccuracies, thus raising concerns about previous overestimates of potential treatment effects.

The effects of adjunctive use of a desiccant agent in the treatment of stage III periodontitis (Randomized controlled clinical trial)

Introduction

Several bacterial species inhabiting the dental plaque biofilms are associated with periodontitis.

Objective

The main objective of this study was to compare the efficacy of the desiccant agent HYBENX (HBX) as an adjunct to scaling and root planning (SRPX) versus scaling and root planning (SRP) alone in the treatment of periodontitis.

Materials and Methods

The study sample comprised 25 patients with periodontitis stage Ш (grades A and B). Each maxillary quadrant was randomly allocated to two groups: SRPX group, including 25 quadrants treated with SRP plus HYBENX, and SRP group, including 25 quadrants treated with SRP alone. The following clinical periodontal parameters were recorded at baseline (immediately after treatment, T0), and 1 month (T1), 3 months (T3), and 6 months (T6) after treatment: probing pocket depth (PPD), relative attachment level (RAL), plaque index (PLI), gingival index (GI), gingival height (GH), and bleeding on probing index (BOP).

Results

Comparisons within each study group showed that all clinical parameters significantly improved (P < 0.001) at all follow-up intervals. In contrast, a statistically significant difference (P < 0.001) was observed in RAL, PPD, BOP, and GI indices at all follow-up intervals between the SRPX and SRP groups. In contrast, no significant differences (P > 0.05) were found in GH and PLI between the study groups.

Conclusion

Both treatment groups showed improved periodontal parameters. However, applying desiccant gel as an adjunct to SRP was significantly effective in the treatment of stage III periodontitis.

Antimicrobial and Pro-Osteogenic Coaxially Electrospun Magnesium Oxide Nanoparticles-Polycaprolactone /Parathyroid Hormone-Polycaprolactone Composite Barrier Membrane for Guided Bone Regeneration

Introduction

An antibacterial and pro-osteogenic coaxially electrospun nanofiber guided bone regeneration (GBR) membrane was fabricated to satisfy the complicated and phased requirements of GBR process.

Methods

In this study, we synthesize dual-functional coaxially electrospun nanofiber GBR membranes by encapsulating parathyroid hormone (PTH) in the core layer and magnesium oxide nanoparticles (MgONPs) in the shell layer (MgONPs-PCL/PTH-PCL). Herein, the physicochemical characterization of MgONPs-PCL/PTH-PCL, the release rates of MgONPs and PTH, and antibacterial efficiency of the new membrane were evaluated. Furthermore, the pro-osteogenicity of the membranes was assessed both in-vitro and in-vivo.

Results

We successfully fabricated a coaxially electrospun nanofiber MgONPs-PCL/PTH-PCL membrane with the majority of nanofibers (>65%) ranged from 0.40~0.60μm in diameter. MgONPs-PCL/PTH-PCL showed outstanding antibacterial potential against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) through the release of MgONPs. We also discovered that the incorporation of MgONPs significantly prolonged the release of PTH. Furthermore, both the in-vivo and in-vitro studies demonstrated that high dosage of PTH promoted pro-osteogenicity of the membrane to improve bone regeneration efficacy with the presence of MgONPs.

Conclusion

The new composite membrane is a promising approach to enhance bone regeneration in periodontitis or peri-implantitis patients with large-volume bone defects.

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.

Impact of Red Complex Bacteria and TNF-α Levels on the Diabetic and Renal Status of Chronic Kidney Disease Patients in the Presence and Absence of Periodontitis

Scientific evidence shows a positive association in the etiopathogenesis of periodontitis and chronic kidney disease (CKD). Various confounding factors, such as obesity, diabetes, and inflammation, also play a significant role in the progression of CKD, which remains unexplored. We hypothesise the role of red complex bacteria with various confounding factors associated with chronic kidney disease. The study comprised a total of 120 participants categorised into 4 groups: the control group (C), periodontitis subjects without CKD (P), periodontally healthy chronic kidney disease subjects (CKD), and subjects having both periodontitis and CKD (P + CKD), with 30 subjects in each group. Demographic variables, and periodontal, renal, and diabetic parameters were recorded. Tumour necrosis factor (TNF)-α levels and those of red complex bacteria such as Prophyromonas gingivalis (P.g), Treponema denticola (T.d), and Tonerella forsythia (T.f) were assessed, and the obtained results were statistically analysed. Among the various demographic variables, age showed a level of significance. Mean PI, GI, CAL, and PPD (the proportion of sites with PPD ≥ 5 mm and CAL ≥ 3 mm) were elevated in the P + CKD group. Diabetic parameters such as fasting blood sugar (FBS) and HbA1c levels were also greater in the P + CKD group. Renal parameters such as eGFR and serum creatinine levels were greater in CKD patients. The estimation of red complex periodontal pathogens such as Pg, Td and Tf levels were significantly greater in the P and P + CKD groups. Pearson correlation analysis revealed significant correlation of red complex bacteria with all variables. Greater levels of P.g, T.d and T.f were found in the P groups, thus indicating their important role in the initiation and progression of inflammation of periodontitis and CKD, with diabetes as one of the confounding factors. The study also confirmed a log-linear relationship between TNF-α levels and red complex bacteria, thereby demonstrating the role of inflammatory biomarkers in periodontal disease progression that could contribute to the development of systemic inflammation such as CKD.