Periodontal Applications Research Articles

Defensins in Periodontics: A Comprehensive Review

Periodontal diseases, such as gingivitis and periodontitis, are inflammatory disorders that impact the tissues supporting the teeth. These diseases are initiated by bacterial plaque biofilms that form on the tooth surface. The host's immune response to this bacterial challenge plays a crucial role in disease progression. Among the various components of the immune system, antimicrobial peptides (AMPs) such as defensins have gained significant attention for their role in maintaining oral health and their potential therapeutic applications in periodontics. This review article explores the biology, function, and therapeutic potential of defensins in periodontal health and disease.

Biologics Agents in Periodontal Regeneration:A Review

The field of periodontology and dental implantology has witnessed significant advancements in the use of molecular mediators and biologic agents over the past decade. Periodontal regeneration, which involves the complete restoration of cementum, bone, and connective tissue following removal of epithelial tissues, is considered superior to tissue repair. Recent research has focused on utilizing biologic materials as complementary therapies to enhance regeneration by accelerating wound healing. These biologic agents were investigated using the following search terms: tissue engineering, intercellular signaling molecules, and biological factors. Enamel matrix derivative (EMD), platelet-derived growth factor (PDGF), platelet-rich plasma, bone morphogenetic proteins (BMPs), fibroblast growth factor (FGF), and parathyroid hormone (PTH) have demonstrated the capacity to stimulate both hard and soft tissue regeneration. However, no single biologic agent is universally effective, necessitating a case-by-case evaluation for optimal treatment selection. Currently, EMD and PDGF are the only biologic therapies approved by the FDA for periodontal regeneration, while BMP-2 is indicated for bone augmentation. Due to a lack of FDA approval for periodontal applications, the clinical use of FGF and PTH in this context is not recommended.

Development of Cerium Oxide-Laden GelMA/PCL Scaffolds for Periodontal Tissue Engineering.

This study investigated gelatin methacryloyl (GelMA) and polycaprolactone (PCL) blend scaffolds incorporating cerium oxide (CeO) nanoparticles at concentrations of 0%, 5%, and 10% w/w via electrospinning for periodontal tissue engineering. The impact of photocrosslinking on these scaffolds was evaluated by comparing crosslinked (C) and non-crosslinked (NC) versions. Methods included Fourier transform infrared spectroscopy (FTIR) for chemical analysis, scanning electron microscopy (SEM) for fiber morphology/diameters, and assessments of swelling capacity, degradation profile, and biomechanical properties. Biological evaluations with alveolar bone-derived mesenchymal stem cells (aBMSCs) and human gingival fibroblasts (HGFs) encompassed tests for cell viability, mineralized nodule deposition (MND), and collagen production (CP). Statistical analysis was performed using Kruskal-Wallis or ANOVA/post-hoc tests (α = 5%). Results indicate that C scaffolds had larger fiber diameters (~250 nm) compared with NC scaffolds (~150 nm). NC scaffolds exhibited higher swelling capacities than C scaffolds, while both types demonstrated significant mass loss (~50%) after 60 days (p < 0.05). C scaffolds containing CeO showed increased Young's modulus and tensile strength than NC scaffolds. Cells cultured on C scaffolds with 10% CeO exhibited significantly higher metabolic activity (>400%, p < 0.05) after 7 days among all groups. Furthermore, CeO-containing scaffolds promoted enhanced MND by aBMSCs (>120%, p < 0.05) and increased CP in 5% CeO scaffolds for both variants (>180%, p < 0.05). These findings underscore the promising biomechanical properties, biodegradability, cytocompatibility, and enhanced tissue regenerative potential of CeO-loaded GelMA/PCL scaffolds for periodontal applications.

Harnessing the power of amnion-chorion membrane in periodontal therapy: A comprehensive review

Amnion-chorion membrane (ACM) has emerged as a versatile biomaterial with immense potential in various medical and dental applications, including periodontal therapy. ACM possesses unique properties, including a bioactive matrix rich in growth factors, anti-inflammatory and antibacterial attributes, and a remarkably thin, self-adherent structure. These characteristics make ACM well suited for various periodontal applications, such as intrabony defect treatment, gingival recession management, socket preservation, papillary preservation, and sinus membrane repair. This review offers comprehensive details of the properties, applications, and implications of ACM membranes in the realm of periodontal treatment.

Mini Review Article] Practicality of Piezo Surgery in Periodontics

The ongoing advances in periodontics, have led to the introduction of Piezosurgery, which has been rejuvenating in the field of osseous surgeries. Piezosurgery® device is based on the piezoelectric effect by ultrasonic vibrations. The linear vibrations and cavitation effect gives blood free zone for clear visibility and operating accuracy. The display unit guides the user to choose from a variety of operational settings that optimize the ultrasonic frequency for desired procedures. It has various applications in periodontics particularly in osteotomy procedures and implant dentistry.

Multifunctional bilayer nanofibrous membrane enhances periodontal regeneration via mesenchymal stem cell recruitment and macrophage polarization

The continuous stimulation of periodontitis leads to a decrease in the number of stem cells within the lesion area and significantly impairing their regenerative capacity. Therefore, it is crucial to promote stem cell homing and regulate the local immune microenvironment to suppress inflammation for the regeneration of periodontitis-related tissue defects. Here, we fabricated a novel multifunctional bilayer nanofibrous membrane using electrospinning technology. The dense poly(caprolactone) (PCL) nanofibers served as the barrier layer to resist epithelial invasion, while the polyvinyl alcohol/chitooligosaccharides (PVA/COS) composite nanofiber membrane loaded with calcium beta-hydroxy-beta-methylbutyrate (HMB-Ca) acted as the functional layer. Material characterization tests revealed that the bilayer nanofibrous membrane presented desirable mechanical strength, stability, and excellent cytocompatibility. In vitro, PCL@PVA/COS/HMB-Ca (P@PCH) can not only directly promote rBMSCs migration and differentiation, but also induce macrophage toward pro-healing (M2) phenotype-polarization with increasing the secretion of anti-inflammatory and pro-healing cytokines, thus providing a favorable osteoimmune environment for stem cells recruitment and osteogenic differentiation. In vivo, the P@PCH membrane effectively recruited host MSCs to the defect area, alleviated inflammatory infiltration, and accelerated bone defects repair. Collectively, our data indicated that the P@PCH nanocomposite membrane might be a promising biomaterial candidate for guided tissue regeneration in periodontal applications.

ULTRASONOGRAPHY – A DIAGNOSTIC SURROGATE IN PERIODONTOLOGY

Ultrasound in dentistry uses the transmission and reflection of acoustic energy. The propagated pulse and its reflection are received both by the transducer (Ultrasonic probe). Clinically, transducers generate ultrasound, which converts electrical energy into ultrasonic waves. Basic knowledge and other secondary effects of ultrasound are essential for developing techniques of application. It has several applications in dentistry and periodontics and is used to treat and maintain periodontal health. Periodontal ultrasonography provides a non-invasive diagnostic method for measuring pocket depth and assessing periodontal health. Additionally, the low-intensity pulsed ultrasound effectively evaluates periodontal healing and demonstrates the potential for periodontal regeneration.

Preparation and In Vitro Characterization of Lactococcus lactis-Loaded Alginate Particles as a Promising Delivery Tool for Periodontal Probiotic Therapy.

Probiotic microorganisms are used in a variety of food supplements and medical formulations to promote human health. In periodontal therapy, probiotics are mainly used in the form of gels, tablets or rinses that often tend to leak from the periodontal pocket, resulting in a strongly reduced therapeutic effect. In this pilot in vitro study, we present biodegradable alginate-based particles as an alternative, highly efficient system for a periodontal delivery of probiotic bacteria to the inflammation site. For this purpose, Lactococcus (L.) lactis was encapsulated using a standardized pump-controlled extrusion-dripping method. Time-dependent bacterial release in artificial saliva was investigated over 9 days. The effect of freeze drying was explored to ensure long-term storage of L. lactis-loaded particles. Additionally, the particles were bound to dentin surface using approved bioadhesives and subjected to shear stress in a hydrodynamic flow chamber that mimics the oral cavity in vitro. Thus, round particles within the range of 0.80-1.75 mm in radius could be produced, whereby the diameter of the dripping tip had the most significant impact on the size. Although both small and large particles demonstrated a similar release trend of L. lactis, the release rate was significantly higher in the former. Following lyophilization, particles could restore their original shape within 4 h in artificial saliva; thereby, the bacterial viability was not affected. The attachment strength to dentin intensified by an adhesive could resist forces between 10 and 25 N/m2. Full degradation of the particles was observed after 20 days in artificial saliva. Therefore, alginate particles display a valuable probiotic carrier for periodontal applications that have several crucial advantages over existing preparations: a highly stable form, prolonged continuous release of therapeutic bacteria, precise manufacturing according to required dimensions at the application site, strong attachment to the tooth with low risk of dislocation, high biocompatibility and biodegradability.

Three-Dimensional Printing Methods for Bioceramic-Based Scaffold Fabrication for Craniomaxillofacial Bone Tissue Engineering.

Three-dimensional printing (3DP) technology has revolutionized the field of the use of bioceramics for maxillofacial and periodontal applications, offering unprecedented control over the shape, size, and structure of bioceramic implants. In addition, bioceramics have become attractive materials for these applications due to their biocompatibility, biostability, and favorable mechanical properties. However, despite their advantages, bioceramic implants are still associated with inferior biological performance issues after implantation, such as slow osseointegration, inadequate tissue response, and an increased risk of implant failure. To address these challenges, researchers have been developing strategies to improve the biological performance of 3D-printed bioceramic implants. The purpose of this review is to provide an overview of 3DP techniques and strategies for bioceramic materials designed for bone regeneration. The review also addresses the use and incorporation of active biomolecules in 3D-printed bioceramic constructs to stimulate bone regeneration. By controlling the surface roughness and chemical composition of the implant, the construct can be tailored to promote osseointegration and reduce the risk of adverse tissue reactions. Additionally, growth factors, such as bone morphogenic proteins (rhBMP-2) and pharmacologic agent (dipyridamole), can be incorporated to promote the growth of new bone tissue. Incorporating porosity into bioceramic constructs can improve bone tissue formation and the overall biological response of the implant. As such, employing surface modification, combining with other materials, and incorporating the 3DP workflow can lead to better patient healing outcomes.

Engineering antibacterial shrinkage‐free trinary PLGA‐based GBR membrane for bone regeneration

AbstractThe purpose of this study was preparation of a multilayer electrospun poly (lactic‐co‐glycolic acid) (PLGA)‐based guided bone regeneration (GBR) membrane with controlled shrinkage behavior and alveolar bone regeneration property. First, PLGA copolymer, and zinc‐doped hydroxyapatite (Zn‐HAp) particles were prepared and characterized using fourier transform infrared spectroscopy, differential scanning calorimetry (DSC), proton nuclear magnetic resonance, and X‐ray diffraction analysis. Since the electrospun PLGA scaffolds showed about 80% shrinkage at physiological conditions (phosphate‐buffered saline, 37°C), the effect of factors such as fiber‐alignment, and additives including natural polymers such as gelatin and chitosan, and Zn‐HAp particles; as well as solution preparation method was investigated on the shrinkage ratio. The results showed that it is possible to eliminate the shrinkage of the scaffold in the physiological environment through appropriate design of a tri‐layer PLGA‐CHI/PLGA‐Gel/PLGA‐Gel‐ZnHAp membrane. The designed tri‐layer membrane demonstrated a bubble point smaller than 7 μm, and improved mechanical properties compared with the individual sub‐layer scaffolds. Additionally, it exhibited enhanced antibacterial activity when compared with a similar three‐layer membrane in which HAp was used instead of Zn‐HAp. This observation suggests a synergistic antibacterial effect resulting from the presence of both zinc ions in Zn‐HAp and chitosan . Osteogenic differentiation of adipose‐derived mesenchymal stem cells cultured on the optimal multilayer composite scaffold, was investigated using alkaline phosphatase and Alizarin red staining assays, and the results suggested that the scaffold could support osteogenic differentiation of the stem cells. The designed membrane was implanted in critical size (1 cm) mandibular defects in dogs, and bone regeneration was monitored by computed tomography. Defects treated with the GBR membrane, and the control group showed 69.31% and 44.63%, newly mineralized tissue, respectively, after 8 weeks post implantation. Based on our results, the engineered 3‐layer scaffold is a promising candidate as a GBR membrane for periodontal applications.

PERIODONTICS IN ARTIFICIAL INTELLIGENCE ERA : A LITERATURE REVIEW

Introduction: Artificial intelligence (AI) involves the creation of computer systems that imitate human actions, and it is progressively adopted as a supportive tool in aiding clinicians with disease diagnosis and treatment. One prevalent global ailment is periodontitis, which leads to the degradation and loss of the tooth-supporting tissues. The aim of this review is to evaluate existing literature that delineates the influence of AI on diagnosing and studying the prevalence of this condition. Review: A Pubmed advanced search with narrative review was conducted of the past ten years using several search term such as “artificial Intelligences” and “periodontics”. Thorough searches were conducted on Pubmed in June 2023, encompassing studies where AI functioned as the independent variable for assessing, diagnosing, or treating patients with periodontitis. After eliminating duplicates, a total of 100 articles were recognized for preliminary abstract scrutiny. Of these, 76 documents were excluded, resulting in 24 texts for comprehensive evaluation. Conclusion: The development of artificial intelligence in the field of dentistry requires more systematic reviews and meta-analyses to enhance the knowledge and scope of artificial intelligence applications. AI models for periodontal applications are still under development and in the future, they have the potential to support diagnostic accuracy capability.

Periodontal application of ozone therapy

The prevalence of periodontium-related problems has been rising globally, impacting individuals across various age groups. Hence, it is crucial for the medical fraternity to address the treatment and subsequently prioritize prevention of the same. Periodontal infections involve the invasion by various bacterial inhabitants deep within the healthy pockets, leading to progressive recession with bone loss and tooth mobility, resulting in periodontitis. Therefore, effective decontamination of periodontal pockets is of paramount importance. Ozone, a natural constituent of the earth’s atmosphere, has now revolutionized the field of medicine since its introduction. Due to its highly unstable and oxidizing form, its procurement and implementation of ozone were challenging initially. The recent advancement in technologies has made it possible to stabilize ozone, enabling comprehensive approaches to major ailments. This literature review intends to illustrate ozone therapy and its diversified application as an adjunct in surgical and nonsurgical periodontal therapies. Ozone therapy has proven its potentiality by promising faster tissue regeneration, aiding in wound healing to effectively decontaminate the pocket depths, resulting in a successful prognosis. The review explores diverse systems and products used for ozone generation across different modalities, with limitations of the same. Evidence provided in the literature will contribute to a better understanding of ozone therapy’s role in improving periodontal health and guide future research in this field.

The Application of Artificial Intelligence in Medical Diagnostics: A New Frontier

This study reviews the latest progress in the application of artificial intelligence (AI) in the medical field, focusing on the application of AI technology in clinical diagnosis, medical equipment management, dentistry, ophthalmology and surgical care. By analyzing multiple academic documents, this article deeply explores the role of AI in improving the accuracy of medical diagnosis, the efficiency of clinical skills training, and medical equipment management. In particular, the literature review points out the efficient performance of convolutional neural networks (CNN) in processing medical images, and its potential applications in periodontics and ophthalmology diagnosis. At the same time, this article also discusses the ethical and legal challenges faced by AI in the medical field, as well as potential directions for future development. These findings not only reveal the huge potential of AI technology in the medical field, but also highlight the ethical and governance issues that need to be considered when promoting these technologies. Overall, this review provides a comprehensive perspective for understanding the current applications and future development of AI in the medical field.

Fabrication of polymeric composite GTR membrane from eggshell powder, polylactic acid and polyethylene glycol for periodontal application: in vitro evaluation

This study aims to fabricate, characterize and evaluate Guided tissue regeneration (GTR) membrane containing eggshell (ES), chlorhexidine (CHX) and polymeric matrix for periodontal application. ES powder ground to size 74 µm was mixed in Polylactic Acid (PLA) and Polyethylene Glycol (70:30 ratios) mixture in 10% and 30% wt to fabricate the membrane and named groups C-10 and C-30. Along with this, 0.25% and 0.5% CHX powder were adsorbed on ES powder and incorporated in PLA and PEG mixture to fabricate drug containing groups C-10CHX and C-30CHX respectively. UTM was used to measure tensile strength, Young’s Modulus, and percent elongation of the prepared GTR membrane. Experimental groups containing 10% ES powder (C-10 and C-30) had adequate tensile properties. The percent mass change of the samples was calculated by the change in weight of the samples (Wd) from the weight of samples after immersion in phosphate-buffered saline PBS (Wt). Contact angle measurement showed that all membranes were found to be hydrophilic (contact angle&amp;lt;90). Groups containing the drug CHX (C-10CHX and C-30CHX) had significant disc diffusion antibacterial activity. Cell viability assay was carried out by Alamar Blue Assay using mouse fibroblasts NIH3T3 and pre-osteoblasts that indicated very good biocompatibility of the groups (C, C-10, C-30, and C-10CHX) while experimental group C-30CHX showed slight cytotoxicity (Cell Viability &amp;gt;70%).

New Insights in Hydrogels for Periodontal Regeneration.

Periodontitis is a destructive inflammatory disease characterized by microbial infection that damages the tissues supporting the tooth (alveolar bone, gingiva, periodontal ligament, and cementum), ultimately resulting in the loss of teeth. The ultimate goal of periodontal therapy is to achieve the regeneration of all of the periodontal tissues. Thus, tissue engineering approaches have been evolving from simple membranes or grafts to more complex constructs. Hydrogels are highly hydrophilic polymeric networks with the ability to simulate the natural microenvironment of cells. In particular, hydrogels offer several advantages when compared to other forms of scaffolds, such as tissue mimicry and sustained drug delivery. Moreover, hydrogels can maintain a moist environment similar to the oral cavity. Hydrogels allow for precise placement and retention of regenerative materials at the defect site, minimizing the potential for off-target effects and ensuring that the treatment is focused on the specific defect site. As a mechanism of action, the sustained release of drugs presented by hydrogels allows for control of the disease by reducing the inflammation and attracting host cells to the defect site. Several therapeutic agents, such as antibiotics, anti-inflammatory and osteogenic drugs, have been loaded into hydrogels, presenting effective benefits in periodontal health and allowing for sustained drug release. This review discusses the causes and consequences of periodontal disease, as well as the advantages and limitations of current treatments applied in clinics. The main components of hydrogels for periodontal regeneration are discussed focusing on their different characteristics, outcomes, and strategies for drug delivery. Novel methods for the fabrication of hydrogels are highlighted, and clinical studies regarding the periodontal applications of hydrogels are reviewed. Finally, limitations in current research are discussed, and potential future directions are proposed.

Immunomodulators and Their Applications in Dentistry and Periodontics: A Comprehensive Review

Immunomodulators and Their Applications in Dentistry and Periodontics: A Comprehensive Review

Can Graphene Pave the Way to Successful Periodontal and Dental Prosthetic Treatments? A Narrative Review.

Graphene, as a promising material, holds the potential to significantly enhance the field of dental practices. Incorporating graphene into dental materials imparts enhanced strength and durability, while graphene-based nanocomposites offer the prospect of innovative solutions such as antimicrobial dental implants or scaffolds. Ongoing research into graphene-based dental adhesives and composites also suggests their capacity to improve the quality and reliability of dental restorations. This narrative review aims to provide an up-to-date overview of the application of graphene derivatives in the dental domain, with a particular focus on their application in prosthodontics and periodontics. It is important to acknowledge that further research and development are imperative to fully explore the potential of graphene and ensure its safe use in dental practices.

Fabrication and characterization of chlorhexidine gluconate loaded poly(vinyl alcohol)/45S5 nano-bioactive glass nanofibrous membrane for guided tissue regeneration applications.

Polymeric barrier membranes are used in periodontal applications to prevent fibroblastic cell migration into the cavities of bone tissue and to properly guide the proliferation of tissues. In this study, the fabrication, characterization, bioactivity, and in vitro biological properties of polyvinyl alcohol-based nanofibrous membranes containing nano-sized 45S5 bioactive glass (BG) loaded with chlorhexidine (CH) gluconate with biocompatible, bioactive, and antibacterial properties for using as dental barrier membranes were investigated. Nanofibrous membranes with an average fiber diameter, pore size, and porosity of 210 nm, 24.73 μm, and 12.42%, respectively, were loaded with 1% and 2% CH, and the release profile was investigated. The presence of BG in the membranes promoted fibroblastic proliferation and the presence of CH provided antibacterial properties. Nanofibrous membranes exhibit a high ability to restrict bacterial growth while fulfilling the necessary conditions for use as a dental barrier thanks to their low swelling rates, significant surface bioactivities, and appropriate degradation levels.

3D printed scaffolds in bone tissue engineering and their application in periodontology

Scaffolds are three-dimensional (3D) porous, fibrous, or permeable biomaterials that promote cell interaction, viability, and extracellular matrix (ECM) deposition while causing minimal inflammation and toxicity and bio-degrading at a controlled rate. This narrative review focuses on 3D scaffolds, the first key component of the tissue engineering paradigm. It describes the classification of scaffolds, their properties, biomaterials used in their fabrication, and in brief their periodontal application.

Rational Design of Bioactive Hydrogels toward Periodontal Delivery: From Pathophysiology to Therapeutic Applications

AbstractPeriodontitis is a biofilm‐induced, host‐mediated inflammatory disease that results in periodontal tissue destruction. The design of functional biomaterials based on disease pathophysiology is essential for enhancing their therapeutic effects in periodontitis treatment. As promising localized drug delivery systems and tissue engineering scaffolds, hydrogels have gained significant interest for controlled and sustained release of bioactive agents in periodontal applications. The rational design of bioactive hydrogels can facilitate bacterial control and modulate destructive host inflammation, thereby preventing the progression of periodontitis. In this review, the pathophysiological mechanisms underlying periodontitis as fundamental principles for the design of functional hydrogel systems are first introduced. In the following part, an overview is systematically provided of the types and functions of the bioactive hydrogel systems loaded with anti‐bacterial and anti‐inflammatory agents for periodontal delivery. Finally, the remaining challenges and future perspectives of hydrogel delivery systems for periodontal applications are proposed. It is believed that this review will inspire the rational design and development of innovative functional hydrogel biomaterials toward periodontal therapy.