Periodontal Applications Research Articles

Photobiomodulation: Molecular and Subcellular Mechanisms and Applications in Periodontal Therapy

Low-level laser therapy (LLLT) is a light source that generates light of a single wavelength. Low-level Laser do not cause temperature elevation within the tissue, but rather produce their effects from photobiostimulation within the tissues. Low-level LASERS do not cut or ablate the tissue. The application of LLLT has become popular in a variety of clinical applications in periodontics including promotion of analgesic effect, reduction of inflammation, and edema and wound healing following nonsurgical and surgical procedures. This review focuses on the molecular and subcellular mechanism of low intensity LASER therapy and their applications in periodontal therapy.

Bioactive Glass Applications in Different Periodontal Lesions: A Narrative Review

Tissue engineering in the orofacial region with bioactive components by the activation of immune complexes or other proteins is the current focus of biomaterials research. Consequently, natural ground materials and tissue components are being created. Bioactive glass is one of the most promising biomaterials and has bioactive properties making it suited for a range of different clinical dental applications, including the regeneration of hard tissues in the craniofacial region. This narrative review provides a summary of the favorable properties and recent applications of bioactive glass materials for the management of periodontal lesions. Bioactive glass mimics natural calcified tissues in terms of composition and has a bioactive role in bone regeneration. The present review concluded that bioactive glass materials have a promising potential for various periodontal applications including the repair of infrabony defects, gingival recession, furcation defects, and guided tissue regeneration. However, further in vivo studies and clinical trials are warranted to advance and validate the potential of bioactive glass for periodontal applications and translate its usage in dental clinics for periodontology.

Platelet Rich Plasma : A Boon To Periodontics

Platelet-rich plasma (PRP), a recently developed autologous cellular therapy, has the potential to perform new functions in an array of regenerative pharmacological treatment plans. Platelet growth factors (PGFs) promote the three stages of the wound recovery and repair cascade, which is the cornerstone of PRP therapy (inflammation, proliferation, remodelling). In vitro, in vivo, and animal experiments were used to test a wide range of PRP formulations. Yet, because it is difficult to apply the findings and technique recommendations from non-clinical studies to human clinical treatment protocols, recommendations from in vitro and animal research frequently result in various clinical manifestations. In this study, we addressed recent advancements in PRP production and composition, applications in periodontics, and PRP mechanisms relating to tissue inflammation and angiogenesis.

Bench-to-bedside: Feasibility of nano-engineered and drug-delivery biomaterials for bone-anchored implants and periodontal applications.

Nanotechnology and drug-release biomaterials have been thoroughly explored in the last few years aiming to develop specialized clinical treatments. However, it is rare to find biomaterials associated with drug delivery properties in the current dental market for application in oral bone- and periodontal-related procedures. The gap between basic scientific evidence and translation to a commercial product remains wide. Several challenges have been reported regarding the clinical translation of biomaterials with drug-delivery systems (BDDS) and nanofeatures. Therefore, processes for BDDS development, application in preclinical models, drug delivery doses, sterilization processes, storage protocols and approval requirements were explored in this review, associated with tentative solutions for these issues. The diversity of techniques and compounds/molecules applied to develop BDDS demands a case-by-case approach to manufacturing and validating a commercial biomaterial. Promising outcomes such as accelerated tissue healing and higher antibacterial response have been shown through basic and preclinical studies using BDDS and nano-engineered biomaterials; however, the adequate process for sterilization, storage, cost-effectiveness and possible cytotoxic effects remains unclear for multifunctional biomaterials incorporated with different chemical compounds; then BDDSs are rarely translated into products. The future benefits of BDDS and nano-engineered biomaterials have been reported suggesting personalized clinical treatment and a promising reduction in the use of systemic antibiotics. Finally, the launch of these specialized biomaterials with solid data and controlled traceability onto the market will generate strong specificity for healthcare treatments.

Fabrication and characterization of stimuli responsive scaffold/bio-membrane using novel carrageenan biopolymer for biomedical applications

Bio-membrane/scaffold plays a vital role in tissue regeneration in medical field, especially in periodontal applications. Biopolymers such as alginate, gelatin, chitosan, and collagen are widely used in biomedical applications. A combination of carrageenan and PVA is used in this study and its physical and mechanical properties were tested. In this study, carrageenan biopolymer along with poly (vinyl) alcohol with (3-aminopropyl) triethoxysilane (APTES) cross-linker was used to fabricate scaffold/bio-membrane. The bio-membrane was tested for its physical, mechanical and thermal properties such as swelling analysis, contact angle, FTIR, tensile strain and stress, TG-DSC, SEM. The bio-membrane strength (89.21 MPa) was found much higher than commercial membrane. The surface of the membrane is smooth and it favors cell adhesion and proliferation. This study established that cross-linked carrageenan biopolymer with PVA using APTES with improved mechanical strength can be applied as scaffold material for dental and other medical applications.

Intraoral Ultrasonography for Periodontal Tissue Exploration: A Review.

This systematic review aims to investigate the possibilities of ultrasound imaging in the field of periodontal tissues exploration to visualize periodontal anatomical structures and to assess reliability in clinical evaluation using the PRISMA guidelines. An electronic search through the MEDLINE database was realized to identify studies that have explored ultrasonography in the field of periodontal imaging published from 2000 to March 2022. The search resulted in 245 records; after exclusions, a total of 15 papers were included in the present review. Various publications have shown the possibility of using intraoral ultrasound for a precise exploration of intraoral tissues and to perform measurements of periodontal structures. Studies argue that ultrasounds open the prospect of a complete paradigm shift on the diagnosis and follow-up of periodontal disease. However, there is currently no clinical device dedicated to periodontal ultrasound. This field is still under-studied, and studies are needed to explore the large field of applications from periodontal assessment to treatment reassessment, including surgery. Researchers should focus their efforts to develop special intraoral ultrasound device and explore the possibilities of clinical periodontal applications.

Laser—an emerging tool in surgical periodontal therapy: An overview

The use of lasers in dentistry, particularly in periodontics and peri-implant diseases, is becoming increasingly common nowadays. Since their introduction in the late 20th century, they have revolutionized the treatment options available for the management of periodontal disease. They allow the clinician to reach inside the deeper pockets and help in reducing the bacterial load. They offer various advantages and have variations according to their clinical use. This review presents an overview of their applications in periodontics.

Metabolomics: A Pioneering Technology for Periodontal Research and Personalised Medicine

Metabolomics involves the identification and quantitative analysis of all small metabolites present in cells, tissues, and bodily fluids that are formed as a result of biochemical reactions within the cell. These metabolites form a large pool of substrates and can be modified by serving as a substrate for enzymes involved in other metabolic pathways. Therefore, the metabolome in an organism is so dynamic that there is variation in their quantity and chemical composition over time. Nuclear Magnetic Resonance (NMR), Gas Chromatography Mass Spectrometry (GC-MS), and Liquid Chromatography Mass Spectrometry (LC-MS) are the most commonly used technologies in metabolomics. The metabolites are first isolated based on their polarity, chemical composition, and structural resemblances, after which they undergo specialised processes and are then analysed. Metabolomics, coupled with MS, has advanced rapidly and found widespread use in periodontal research. The presence of distinct metabolic and microbiological profiles in different types of periodontitis, as well as their link to clinical indicators of periodontal inflammation, has demonstrated the usefulness of metabolomics in screening, preventing, and monitoring prognosis. Conventional diagnostics fail to detect periodontitis in its early stages, cannot discriminate between past and present disease activity, and are incapable of analysing the entire repertoire of biomarkers in the biological system. Therefore, metabolomics, in conjunction with other omics technologies, can provide tailored periodontal disease therapy. The present review aimed to explore metabolomics, its applications in periodontics, and the potential for personalised treatment.

Fibronectin and Its Applications in Dentistry and Periodontics: A Cell Behaviour Conditioner.

The formation of biomaterials is a physical phenomenon that is primarily influenced by the material's chemical and physical characteristics, as well as by the availability of proteins and their mutual interactions. A common extracellular matrix (ECM) glycoprotein called fibronectin (FN) is a biomaterial that is essential for tissue repair. Cellular FN (cFN), also known as the "large external transformation sensitive (LETS) protein" or "galactoprotein,"was found during the quest for tumour markers twenty-five years ago and was later identified as the surface fibroblast antigen. Twenty different isoforms of the FN protein can be created by alternative splicing of a single pre-messenger ribonucleic acid (pre-mRNA) molecule. FN is an outstanding illustration of an ECM protein that intricately influences cell activity. FN is necessary for cell behaviours like cell adhesion, cell migration, and differentiation of cells as well as highly coordinated tissue processes like morphogenesis and wound repair. Plasma FN is absorbed by tissues and deposited in extracellular matrix fibrils along with locally generated cellular FN. cFN is produced by a wide range of cell types, including fibroblasts, endothelial cells, chondrocytes, synovial cells, and myocytes. FN and other cell adhesion proteins can promote cell attachment to tooth surfaces. Periodontal ligament (PDL) cell-ECM interactions, and consequently the regeneration of periodontal tissues, depends on FN. Specific FN segments serve as indicators of periodontal disease status and provide evidence for their potential involvement in the pathophysiology of the condition. FN is an all-purpose biomaterialthat may be utilised for clinical applications ranging from tissue engineering to disease biology. Therefore, it would be desirableto develop materials that specifically bind to FN.

Synthesis and Modification of Gelatin Methacryloyl (GelMA) with Antibacterial Quaternary Groups and Its Potential for Periodontal Applications.

Gelatin methacryloyl (GelMA) hydrogels have been widely used for different biomedical applications due to their tunable physical characteristics and appropriate biological properties. In addition, GelMA could be modified with the addition of functional groups providing inherent antibacterial capabilities. Here, GelMA-based hydrogels were developed through the combination of a GelMA unmodified and modified polymer with quaternary ammonium groups (GelMAQ). The GelMAQ was synthesized from GelMA with a low degree of substitution of methacrylamide groups (DSMA) and grafted with glycidyltrimethylammonium chloride in the free amine groups of the lysine moieties present in the original gelatin. GelMAs with high DSMA and GelMAQ were combined 50/50% or 25/75% (w/w), respectively, and compared to controls GelMA and GelMA with added chlorhexidine (CHX) at 0.2%. The different hydrogels were characterized using 1H-NMR spectroscopy and swelling behavior and tested in (1) Porphyromonas gingivalis to evaluate their antibacterial properties and (2) human gingival fibroblast to evaluate their cell biocompatibility and regenerative properties. GelMA/GelMAQ 25/75% showed good antibacterial properties but also excellent biocompatibility and regenerative properties toward human fibroblasts in the wound healing assay. Taken together, these results suggest that the modification of GelMA with quaternary groups could facilitate periodontal tissue regeneration, with good biocompatibility and added antibacterial properties.

Preparation and characterization of Bomidin-loaded thermosensitive hydrogel for periodontal application

Preparation and characterization of Bomidin-loaded thermosensitive hydrogel for periodontal application

Polymeric nanocomposite multifunctional core-shell membrane for periodontal repair and regeneration applications

Periodontal inflammation injuries affect more than 50% of adults in the society and if left untreated it can result in tooth loss. Here, core-shell nano-fibrous membrane of polycaprolactone/gelatin core and poly (vinyl alcohol)/polyvinylidene fluoride shell is fabricated through electrospining. To facilitate tissue regeneration, bioactive glass nanoparticle (BG) is incorporated within the core and the effect of concentration (10, 25 and 50 wt%) on physical, mechanical and biological properties is thoroughly studied. The diameter of the fibrous structures was 270 ± 25 nm to 510 ± 39 nm. The tensile strength was greatly influenced by the addition of BG such that ultimate tensile stress increased from 2.7 MPa to 3.4 MPa in 0 and 10 wt% BG containing group, respectively. By investigating the piezoelectricity of the membranes, core-shell sample with 25% BG showed the highest output voltage of 39 ± 4 kV m−3. The core-shell sample with 25% BG sample was shown great hemocompatibility with a low hemolysis ratio of 0.5% and platelets attachment test confirmed that the attached platelets were not activated and aggregated or pseudopodium. Drug loaded membrane revealed an antibacterial activity against Staphylococcus aureus bacteria. The cell proliferation was positively influenced by the presence of BG, further confirming the suitability of the resultant structure for periodontal applications.

Comparing the Use of Diode Lasers to Light-Emitting Diode Phototherapy in Oral Soft and Hard Tissue Procedures: A Literature Review.

Objective: In dentistry, patient and physician adoption of diode lasers and light-emitting diodes (LEDs) continues to increase as research indicates that diode lasers and LEDs may be used for surgical and nonsurgical procedures. The goal of this literature review was to critically analyze randomized controlled trials and experimental trials to provide evidence-based recommendations on the therapeutic uses of diode lasers and LEDs in oral applications based on published efficacy and safety data. Methods: A literature review was performed of published literature on patients receiving periodontal and oral surgery treatment that included the use of diode lasers and/or the use of LED phototherapy to determine if the outcomes of phototherapy were superior to conventional therapy and if one form of phototherapy was superior to the other. Results: Eighteen original clinical trials and experimental studies were suitable for review. The diode laser was presented as an effective tool in soft tissue management due to its cutting precision, incision depth, analgesic effects, and elimination of bacterial load and in periodontal applications for probing depth reduction when used as an adjunct to scaling and root planing (SRP). LEDs also served as an effective tool for pain management, wound healing, and efficacy when used as an adjunct to SRP. Other than one study, all the available studies reviewed were either evaluating the efficacy of diode lasers or LEDs, but not both. Therefore, the results for determining the more effective tool were inconclusive. Conclusions: According to existent data, diode lasers and LEDs are equally effective tools for the phototherapy in periodontology and oral surgery. Although fewer studies exist examining the use of LED for phototherapy, the studies all revealed positive results. Further clinical comparative investigations utilizing both diode lasers and LED are needed to determine superiority of this application for periodontal management and oral surgery.

Periodontal suturing, data on selection criteria

Periodontal suturing beyond the surgical elements it provides precedes the selection of the type of suture versus the fact that it is manipulated with periodontal soft tissue. This fact is the basic element in the selection of the type of suture indicated for use and the way of suturing, which in the periodontal surgeon with experience is performed instinctively without thinking. The article is of the review type, bringing a summary of the published data about the suturing method needed for the periodontal application. Conclusion: The type of suture indicated as a primary indication has a clinical case that is indicated based on clinical diagnosis, but the selection of suture type depending on the material or needle is performed based on the clinical area conditioned by minimal manipulation space and the possibility of laceration of periodontal tissue.

Evaluation of Platelet-Derived Extracellular Vesicles in Gingival Fibroblasts and Keratinocytes for Periodontal Applications.

Gingival regeneration aims at restoring the architecture and functionality of oral damaged tissue. Different biomaterials or biological materials have been tested for tissue repair, such as platelet concentrates such as PL. In this article, the use of extracellular vesicles (EVs) derived from platelet lysate (PL) and their combination with hyaluronic acid biomaterials (HA) in an in vitro wound healing assay is investigated. EVs were isolated by size exclusion chromatography from PL. In addition, HA gels were formulated with PL or EVs. EVs or HA combined with EVs (HA-EVs) were tested in vitro in gingival fibroblasts and keratinocytes for biocompatibility (LDH activity and metabolic activity) and by an in vitro wound-healing assay and gene expression analysis. EVs and EVs-HA treatments were biocompatible in gingival fibroblasts and keratinocytes and showed an increase in wound healing in vitro compared to control. Moreover, changes in gene expression related to extracellular matrix remodeling were observed after the treatment with EVs. EVs can be combined with HA biomaterials, showing good biocompatibility and preserving their activity and functionality. Therefore, platelet-derived EVs could emerge as a new application for periodontal regeneration in combination with biomaterials in order to enhance their clinical use.

Peek dental implants coated with boron-doped nano-hydroxyapatites: Investigation of in-vitro osteogenic activity

BackgroundPEEK is a high-performance thermoplastic that has many potential uses in orthopaedics and dentistry, and it has been shown to be a substitute for titanium (Ti) implants. However, PEEK is an inherently inert material, and that characteristic limits its cellular adhesion and bone integration. The aim of this study is to determine a suitable surface modification method for increasing the osteogenic potential of polyetheretherketone (PEEK) implants used in periodontal applications. MethodsIn this work, a nanostructured porous surface is created on PEEK material by sulfonation, in sulfuric acid at room temperature for 20 min, and thus SPEEK samples were obtained. Then, PEEK and SPEEK samples were coated with boron (B) doped hydroxyapatite (HAp) nanoparticles (B-nHAp) precipitated from concentrated synthetic body fluid (10xSBF) by a microwave-assisted method conducted at 600 W. In vitro cell culture studies were carried out with periodontal ligament cells (PDL) on the samples. Osteogenic differentiation of PDL cells on PEEK, SPEEK and SPEEK-B-nHAp was evaluated using ALP activity assay, hydroxyproline assay, and RT-qPCR. ResultsIn vitro cell culture studies disclosed improved adhesion and proliferation of PDL cells on the SPEEK and B-nHAp coated SPEEK surfaces (SPEEK-B-nHAp). Results of these assays confirmed that treated PEEK surfaces, especially SPEEK-B-nHAp, significantly enhanced osteogenic differentiation of PDL cells in vitro compared with untreated PEEK surfaces. ConclusionHere a simple, easy to-use, and efficient modification method based on the properties of boron is proposed for increasing osteogenic potential of PEEK implants.

Sustained release of azithromycin from lipid liquid-crystalline nanoparticles laden in situ gel for the treatment of periodontitis: In vitro and efficacy study.

Periodontitis is a chronic inflammatory disease affecting teeth, periodontal ligament and alveolar bone. Current treatment options include surgery or oral antibiotics. Oral dosage forms shows systemic side effects due to frequent dosing and it failed to reach the therapeutic concentration in the periodontal cavity. In this work, a novel in situ gel loaded with azithromycin laden lipid liquid-crystalline nanoparticles (cubosomes) was formulated for effective treatment of periodontitis. Cubosomes were prepared using DL-α-monoolein (MO) and Pluronic®F-127, and characterized for size, zeta potential, shape, and entrapment efficacy. In situ gel laden cubosomes were evaluated for pH, drug content, viscosity, syringeability, mucoadhesive strength, texture profile, gelation temperature, gel strength, in vitro release profile, antimicrobial activity and in vivo efficacy in rat model. Cubosomal size (137-450nm) and entrapment efficacy (74-88%) increases with increase in the level of MO. The in situ gel-cubosomal batches showed sufficient viscosity (878-956 cp), syringeability (125-150N), mucoadhesive strength (25.7-26.2dyne/cm2), gelation temperature (34.3-35.3oC), gel strength (45-51s), and texture profile for periodontal application. The in vitro release profiles showed sustain azithromycin release for 24h from the in situ gel-cubosomal gels compared to 4h from the marketed azithromycin gel. The in vivo studies (alveolar bone loss and histopathology) in rat model confirmed the efficacy of in situ gel to treat periodontitis at low frequency of dosing compared to marketed gel. In conclusion, the study demonstrated the potential of cubosomes to sustain the release of azithromycin from in situ gelling system for effective treatment of periodontitis.

Injectable metronidazole-eluting gelatin-alginate hydrogels for local treatment of periodontitis.

Infection of the periodontal pocket presents two major challenges for drug delivery: administration into the periodontal pocket and a high fluid clearance rate in the pocket. The current study aimed to develop and study a novel hydrogel system for delivery of the antibiotic drug metronidazole directly into the periodontal pocket via injection followed by in situ gelation. The natural polymers gelatin and alginate served as basic materials, and their crosslinking using a carbodiimide resulted in a dual hydrogel network. The study focused on the effects of the hydrogel's formulation parameters on the drug release profile and the hydrogel's physical and mechanical properties. A cell viability test was conducted on human fibroblasts. The metronidazole-loaded hydrogels demonstrated a decreasing release rate with time, where most of the drug eluted within 24h. These hydrogels exhibited fibroblast viability of at least 75% after 24 and 48h, indicating that they are highly biocompatible. Although the alginate concentration used in this study was relatively low, it had a strong effect on the physical as well as the mechanical properties of the hydrogel. An increase in the alginate concentration increased the crosslinking rate and enabled enhanced entanglement of the 3D structure, resulting in a decrease in the gelation time (less than 10s) and swelling degree, which are both desired for the studied periodontal application. Increasing the gelatin concentration without changing the crosslinker concentration resulted in significant changes in the physical properties and slight changes in the mechanical properties. Metronidazole incorporation slightly decreased the hydrophilicity of the hydrogel and therefore also its viscosity, and affected the sealing ability and the tensile and compression moduli. The developed hydrogels exhibited controllable mechanical and physical properties, can target a wide range of conditions, and are therefore of high significance in the field of periodontal treatment.

A Biostimulation Therapy in Periodontics: An Evidence‑Based Review

Low-level laser therapy (LLLT) is a light source treatment that generates light of a single wavelength. Low-level lasers do not cause temperature elevation within tissue, but rather produce their effects through photobiostimulation. Low-level lasers (LLL) do not cut or ablate tissue. Low-level laser therapy devices include gallium-aluminum-arsenide (Ga-Al-As) infrared semiconductors and helium-neon (He-Ne) lasers. The output powers range from 50 to 500 mW with wavelengths in the red and near infrared of the electromagnetic spectrum, from 630 to 980 nm, with pulsed or continuous-wave emission. The application of LLLT has become popular in a variety of clinical applications in periodontics including the promotion of wound healing and the reduction of pain following non-surgical and surgical procedures. There is good evidence that the enhanced cell metabolic functions seen after LLLT are the result of the activation of photo-receptors within the electron transport chain of mitochondria. The articles included in this review were searched from PubMed, TRIP, Google Scholar, and Cochrane databases. The purpose of this review was to critically analyze the effectiveness of LLLT on soft and hard tissue in order for dentists and specialists to have a clear understanding of the clinical applications of LLLT in periodontal disease.

Laser—An Emerging Tool in Surgical Periodontal Therapy: An Overview

The use of lasers in dentistry, particularly in periodontics and peri-implant diseases, is becoming increasingly common nowadays.Since their introduction in the late 20th century, they have revolutionized the treatment options available for the management of periodontal disease. They allow the clinician to reach inside the deeper pockets and help in reducing the bacterial load. They offer various advantages and have variations according to their clinical use.This review presents an overview of their applications in periodontics.