Treatment Of Periodontitis Research Articles

Advances in the use of chlorhexidine for periodontitis treatment in diabetic patients: A review.

Periodontitis and diabetes mellitus exhibit a bidirectional relationship. This narrative review descriptively outlines the role of chlorhexidine in the periodontal treatment of diabetic patients, focusing on its antimicrobial mechanisms against microbial communities and its antiplaque effects. Although chlorhexidine is proven to be effective in combating microbial presence and improving gingivitis with substantial supporting evidence, its impact on glycemic control and insulin resistance in diabetic patients remains contentious. Additionally, the effectiveness of chlorhexidine as an adjunctive chemotherapeutic in the periodontal treatment of gestational diabetes has not yet been studied, highlighting a gap in research that necessitates further prospective studies and randomized controlled trials. Considering the interconnection between periodontal inflammation and glycemic levels, this article finally advocates for collaborative care between dental and medical professionals to manage periodontitis in diabetic patients effectively.

GPR40/GPR120 Agonist GW9508 Improves Metabolic Syndrome-Exacerbated Periodontitis in Mice.

G protein-coupled receptor (GPR)40 and GPR120 are receptors for medium- and long-chain free fatty acids. It has been well documented that GPR40 and GPR120 activation improves metabolic syndrome (MetS) and exerts anti-inflammatory effects. Since chronic periodontitis is a common oral inflammatory disease initiated by periodontal pathogens and exacerbated by MetS, we determined if GPR40 and GPR120 activation with agonists improves MetS-associated periodontitis in animal models in this study. We induced MetS and periodontitis by high-fat diet feeding and periodontal injection of lipopolysaccharide, respectively, and treated mice with GW9508, a synthetic GPR40 and GPR120 dual agonist. We determined alveolar bone loss, osteoclast formation, and periodontal inflammation using micro-computed tomography, osteoclast staining, and histology. To understand the underlying mechanisms, we further performed studies to determine the effects of GW9508 on osteoclastogenesis and proinflammatory gene expression in vitro. Results showed that GW9508 improved metabolic parameters, including glucose, lipids, and insulin resistance. Results also showed that GW9508 improves periodontitis by reducing alveolar bone loss, osteoclastogenesis, and periodontal inflammation. Finally, in vitro studies showed that GW9508 inhibited osteoclast formation and proinflammatory gene secretion from macrophages. In conclusion, this study demonstrated for the first time that GPR40/GPR120 agonist GW9508 reduced alveolar bone loss and alleviated periodontal inflammation in mice with MetS-exacerbated periodontitis, suggesting that activating GPR40/GPR120 with agonist GW9508 is a potential anti-inflammatory approach for the treatment of MetS-associated periodontitis.

Anti-resorptive medications and periodontitis: critical appraisal, clinical management and ONJ risk

Purpose: This manuscript critically appraised the literature on, and analyzed the clinical scenario of, osteo-metabolic patients affected by periodontitis. Methods: A brief narrative review of literature was performed. The link between periodontitis and osteoporosis, the impact of anti-resorptive (AR) medications on the treatment of periodontitis, and the risk of medication-related osteonecrosis of the jaws (MRONJ) in different clinical scenarios were discussed. Results: Data suggest a bidirectional link between periodontitis and osteoporosis. Patients affected by osteoporosis showed higher risk of periodontitis and periodontitis-induced tissue destruction. Even though treatment with AR medications has been hypothesized to reduce inflammatory periodontal bone resorption, it may not be suggested as an adjunctive intervention in the treatment of periodontitis. Four clinical scenarios were identified: patients waiting for AR treatment, patients treated with bisphosphonates for less than three years, patients treated with bisphosphonates for more than three years, and patients treated with denosumab. The risk of osteonecrosis in each of these cases is described and practical clinical recommendations are provided. Briefly, both non-surgical and surgical treatment of periodontitis may be beneficial for these patients. Conclusions: Periodontitis treatment may be safe and predictable in patients treated with AR medications, keeping the MRONJ risk very low over time. KEY WORDS: Anti-resorptive medications, bisphosphonate, periodontitis, MRONJ.

RETROSPECTIVE ANALYSIS AND CLINICAL OBSERVATIONS OF REGENERATIVE FEATURES OF PERIAPICAL TISSUE

Abstract Background. Chronic forms of periodontitis are accompanied by changes in periapical tissues, untimely diagnosis and lack of full mechanical treatment increases the number of patients diagnosed with chronic periodonitis. Periodontitis, which leads to destructive changes due to a long-term inflammatory process in periapical tissues, is especially dangerous. For this reason, the problem of treating destructive forms of periodontitis is relevant in modern dentistry. The purpose of the study is to study the regeneration of periapical tissues after treatment of patients with chronic forms of periodontitis. Methods. A retrospective analysis of the destruction and restoration of periapical tissues before and after treatment in the period of 3-6 months was carried out in 20 patients. Results. According to the results of a retrospective analysis of X-ray studies, bone tissue destruction of varying degrees was revealed in 20 patients. Poor preparation of the root canals was due to a number of factors, the main one being the anatomy and topography of the root canals. Of the 20 patients requiring treatment for chronic periodontitis with varying degrees of destruction, 16 patients came to the next stage and underwent endodontic treatment. After the treatment, conical preparation of the root canals and the quality of obturation to the radiographic apex of the root were radiographically revealed. In patients with clinical signs of periodontitis, an X-ray examination was performed after 3 months, in patients without clinical manifestations - after 6 months. After 3 months, the X-ray showed a decrease in the foci of bone tissue destruction in the area of the causative tooth, and positive dynamics were determined. Conclusion The study of periapical tissue regeneration after treatment of patients with chronic forms of periodontitis showed that effective apical preparation, high-quality irrigation and root canal filling increases the degree of regeneration in the periodontium. Healing in the periapical tissues is crucial for the success of root canal treatment.

Antimicrobial adhesive self-healing hydrogels for efficient dental biofilm removal from periodontal tissue

ObjectivesOral biofilms, including pathogens such as Porphyromonas gingivalis, are involved in the initiation and progression of various periodontal diseases. However, the treatment of these diseases is hindered by the limited efficacy of many antimicrobial materials in removing biofilms under the harsh conditions of the oral cavity. Our objective is to develop a gel-type antimicrobial agent with optimal physicochemical properties, strong tissue adhesion, prolonged antimicrobial activity, and biocompatibility to serve as an adjunctive treatment for periodontal diseases. MethodsPhenylboronic acid-conjugated alginate (Alg–PBA) was synthesized using a carbodiimide coupling agent. Alg–PBA was then combined with tannic acid (TA) to create an Alg–PBA/TA hydrogel. The composition of the hydrogel was optimized to enhance its mechanical strength and tissue adhesiveness. Additionally, the hydrogel’s self-healing ability, erosion and release profile, biocompatibility, and antimicrobial activity against P. gingivalis were thoroughly characterized. ResultsThe Alg–PBA/TA hydrogels, with a final concentration of 5 wt% TA, exhibited both mechanical properties comparable to conventional Minocycline gel and strong tissue adhesiveness. In contrast, the Minocycline gel demonstrated negligible tissue adhesion. The Alg–PBA/TA hydrogel also retained its rheological properties under repeated 5 kPa stress owing to its self-healing capability, whereas the Minocycline gel showed irreversible changes in rheology after just one stress cycle. Additionally, Alg–PBA/TA hydrogels displayed a sustained erosion and TA release profile with minimal impact on the surrounding pH. Additionally, the hydrogels exhibited potent antimicrobial activity against P. gingivalis, effectively eliminating its biofilm without compromising the viability of MG-63 cells. SignificanceThe Alg–PBA/TA hydrogel demonstrates an optimal combination of mechanical strength, self-healing ability, tissue adhesiveness, excellent biocompatibility, and sustained antimicrobial activity against P. gingivalis. These attributes make it superior to conventional Minocycline gel. Thus, the Alg–PBA/TA hydrogel is a promising antiseptic candidate for adjunctive treatment of various periodontal diseases.

Eco-friendly development of intrinsically antibacterial and mechanically robust self-healing hydrogels using alginate and oval proteins: Advancing periodontitis treatment

A novel approach for fabricating self-healing, intrinsically antibacterial hydrogels for potential periodontitis treatment is presented in this study. Self-healable hydrogels are promising substitutes for brittle hydrogels due to their excellent durability and stability. Drug-loaded regenerative hydrogels have shown good outcomes but face challenges, specifically in managing the development of drug resistance. The hydrogels were prepared by incorporating bioactive oval proteins and hydroxyapatite into polyvinyl alcohol using a simple synthesis method with eco-friendly crosslinkers (oxidized alginate, borax, and divalent metal salts). The synthesized hydrogels exhibited excellent self-healing properties, mechanical robustness, and malleability. Furthermore, characterization techniques confirmed successful crosslinking and interactions within the network. The hydrogels demonstrated significant water absorption, tunable degradation, and potent antibacterial activity against E. coli, S. aureus and P. gingivalis. In vitro studies confirmed good cytocompatibility with epithelial and fibroblasts cells. Wound healing assays further supported the potential of these hydrogels for tissue regeneration applications. This approach offers a promising alternative to traditional drug-loaded hydrogels, overcoming limitations of cost and potential for resistance.

Probiotics, tetracycline fibres and chlorhexidine gel's effectiveness in treating chronic periodontitis as a supplement to scaling and root planning.

A periodontal pocket can result into progressive loss of attachment. Many agents are tried to improve periodontal health. Hence this research was done to estimate the effectiveness of Tetracycline fibers; Probiotics and Chlorhexidine gel as a conjunction to scaling and root planning (SRP) in the treatment of chronic periodontitis. In all, 60 patients between the ages of 25 and 35 who had generalized chronic periodontitis and had a probing pocket depth (PPD) of at least 5 mm were enrolled for this study. Four groups of 15 patients each were created from the patients: Group 1: Tetracycline fibres after SRP, Group 2: Chlorhexidine gel, Group 3: Probiotic mouthwash and Group 4: Rinse with regular saline. At baseline, oral prophylaxis was administered to all groups. Gingival index (GI), Plaque index (PI), and probing depth (PD), among other clinical indicators, were evaluated at baseline, two weeks, and four weeks, respectively. All clinical findings, along withPlaque index (PI), Gingival index (GI), and Probing depth at various time intervals, decreased statistically significantly. Tetracycline fibres, Chlorhexidine gel, and probiotic mouthwash are all similarly effective for treating chronic periodontitis, but they are all more effective than SRP alone, according to an intergroup comparison. When it comes to SRP, local medication delivery methods are beneficial in treating periodontitis.

Effect of ozonated oil versus chlorhexidine gel among Indian patients with chronic periodontitis.

The efficacy of Ozonated oil in treating chronic periodontitis compared to Chlorhexidine gel following Scaling and Root Planing (SRP) is of interest. Fifty-six patients were randomly assigned to two groups: one receiving Ozonated oil post-SRP and the other receiving Chlorhexidine gel. Periodontal indices (Plaque Index, Gingival Index), Periodontal Probing Depth (PPD), and Clinical Attachment Level (CAL) were measured at baseline, one month, and three months. Intragroup comparisons for Plaque and Gingival indices showed statistically significant improvements over time (p < 0.05), but intergroup comparisons did not reveal significant differences. However, both groups demonstrated statistically significant improvements in PPD and CAL at all-time points (p < 0.05). Further research is warranted to explore Ozonated oil's potential as an antimicrobial treatment for chronic periodontitis and other oral microbial infections.

Association of periodontitis with cardiometabolic and haemostatic parameters

ObjectiveTo investigate the association between periodontitis and cardiometabolic and haemostatic parameters.Materials and methodsBetween 2014 and 2019, 54 individuals needing full mouth extraction, and 50 control individuals, were recruited for a combined cross-sectional (individuals versus controls) and longitudinal (individuals before and after extraction) study. Periodontitis severity was measured using the periodontal inflamed surface area (PISA). Blood was drawn to measure the haemostatic (Factor VIII, von Willebrand factor [VWF], endogenous thrombin potential, d-dimer, clot lysis time) and cardiovascular risk (C-reactive protein [CRP], lipid profile) parameters, prior to and 12 weeks post-extraction. The results were analysed group-wise.ResultsThe mean VWF and CRP levels were higher and the high-density lipoprotein levels were lower in the individuals prior to extraction compared to the controls. The VWF was significantly correlated with the PISA (a 21% unit increase in VWF per 1000 mm2 increase in PISA, 95%CI: 6–36%, p = 0.01). The other analyses were comparable between the individuals and controls, and did not change in the individuals after the extraction.ConclusionVWF levels are associated with periodontitis severity; they do not improve after full-mouth extraction. Severe periodontitis in control individuals does not induce substantial changes in their haemostatic or inflammatory systems.Clinical relevanceTreatment of periodontitis has been shown to improve the cardiometabolic blood profile of patients with established cardiometabolic disease. However, whether periodontitis treatment improves cardiometabolic and haemostatic profiles in people without cardiometabolic disease is uncertain.

Mangostanin hyaluronic acid hydrogel as an effective biocompatible alternative to chlorhexidine

Periodontal disease (PD) prevention and treatment products typically demonstrate excellent antibacterial activity, but recent studies have raised concerns about their toxicity on oral tissues. Therefore, finding a biocompatible alternative that retains antimicrobial properties is imperative. In this study, a chemically modified hyaluronic acid (HA) hydrogel containing mangostanin (MGTN) was developed. Native HA was chemically modified, incorporating amino and aldehyde groups in different batches of HA, allowing spontaneous crosslinking and gelation when combined at room temperature. MGTN at different concentrations was incorporated before gelation. The structure, swelling characteristics MGTN release, rheological parameters, and in vitro degradation performance of the loaded hydrogel were first evaluated in the study. Then, antimicrobial properties were tested on Porphyromonas gingivalis and its biocompatibility in 3D-engineered human gingiva. HA hydrogel was very stable and showed a sustained release for MGTN for at least 7 days. MGTN-loaded HA hydrogel showed equivalent antimicrobial activity compared to a commercial gel of HA containing 0.2 % chlorhexidine (CHX). In contrast, while MGTN HA hydrogel was biocompatible, CHX gel showed high cytotoxicity, causing cell death and tissue damage. Modified HA hydrogel allows controlled release of MGTN, resulting in a highly biocompatible hydrogel with antibacterial properties. This hydrogel is a suitable alternative therapy to prevent and treat PD.

Thermo-Responsive Hydrogel Containing Microfluidic Chitosan Nanoparticles Loaded with Opuntia ficus-indica Extract for Periodontitis Treatment.

Periodontitis is a chronic inflammatory disease resulting from the dysbiosis of periodontal bacteria and the host's immune response, leading to tissue degradation and sustained inflammation. Traditional treatments, such as mechanical debridement and antimicrobial agents, often fail to fully eradicate pathogenic bacteria, especially in deep periodontal pockets. Consequently, the need for novel therapeutic approaches has increased the interest in bioactive natural extracts, such as that of Opuntia ficus-indica, known for its anti-inflammatory, antioxidant, and antimicrobial properties. This study investigates the encapsulation of Opuntia ficus-indica extract in OFI-loaded chitosan nanoparticles (OFI-NPs) via ionotropic gelation using a microfluidic system, allowing precise control over nanoparticle characteristics and enhancing protection against enzymatic degradation. To achieve localized and sustained release in periodontal pockets, a thermo-responsive hydrogel comprising hyaluronic acid and Pluronic F127 (OFI@tgels) was developed. The transition of OFI@tgels from a solution at low temperatures to a solid at body temperature enables prolonged drug release at inflammation sites. The in vitro application of the optimized formulation eradicated biofilms of S. mutans, P. aeruginosa (PAO1), and P. gingivalis over 36 h and disrupted extracellular polymeric substance formation. Additionally, OFI@tgel modulated immune responses by inhibiting M1 macrophage polarization and promoting a shift to the M2 phenotype. These findings suggest that OFI@tgel is a promising alternative treatment for periodontitis, effectively reducing biofilm formation and modulating the immune response.

Smoking's impact on pocket closure after nonsurgical periodontal treatment in relation to bleeding on probing.

Our aim was to investigate the impact of smoking on pocket closure at six months after treatment of severe periodontitis, in relation to residual clinical inflammation. The clinical records of deep pockets (probing depth≥6 mm, n&#61;984) in 46 individuals with periodontitis were analyzed. Following baseline clinical assessments (plaque index, probing depth, clinical attachment level, and bleeding on probing), non-surgical periodontal treatment was performed. Clinical assessments were repeated at 2 and 24 weeks after periodontal therapy. A logistic regression model using generalised estimation equations (GEE) adapting the cluster robust standard errors was performed to investigate potential associations between bleeding on probing and pocket closure at post-treatment 24 weeks. Absence of bleeding at two weeks after non-surgical treatment related to pocket closure after six-months. Pockets that do not bleed neither at baseline nor two weeks (OR&#61;2.7; P <.005) and pockets of non-smokers (OR&#61;6.32; P <.001) and females (OR&#61;1.79; P &#61;.022) associated with pocket closure at six months. Pocket closure is associated with being a non-smoker and the absence of inflammation after non-surgical periodontal treatment, which indicates the importance of smoking cessation and inflammation control in achieving optimal clinical outcomes.

Comparison of matrix metalloproteinase levels in periodontal pockets treated with chlorhexidine and propolis

Natural antimicrobial products are attracting interest in the treatment of periodontal diseases due to their minimal or nonexistent side effects. Propolis, a complex resin content produced by bees, has drawn particular interest for its antibacterial effects, including inhibitory effects on periodontopathogenic bacterial species. This study compared the effects of propolis, a natural product, and chlorhexidine, the gold standard antimicrobial agent, on MMP-1 and MMP-9 levels in gingival crevicular fluid (GCF). Subgingival irrigations of chlorhexidine and propolis solutions were performed in selected deep periodontal pockets of periodontitis patients along with scaling and root planing. The treatment protocol was administered three times at one-month intervals starting from the initial day of the study. GCF MMP-1 and MMP-9 levels, along with clinical periodontal parameters, were evaluated before and after treatment. The study results showed that a statistically significant decrease in clinical periodontal parameters in both groups (p&amp;lt;0.001). Biochemical analysis revealed a statistically significant decrease in levels of GCF MMP-1 and MMP-9 in both groups (p&amp;lt;0.005). Additionally, the decrease in GCF MMP-1 levels was found to be significantly greater in the propolis group compared to the chlorhexidine group (p&amp;lt;0.001).

Combined application of Er:YAG laser and low-level laser in non-surgical treatment of periodontitis.

To compare the efficacy of combined treatment of Er:YAG laser (ERL) and low-level laser therapy (LLLT) with single laser applications, and scaling and root planing (SRP) for non-surgical periodontal treatment. In a randomized controlled trial, 25 non-smoking Stage II or Stage III periodontitis patients were recruited. The four intraoral quadrants were randomly assigned to four different treatments: (1) combined application with ERL plus SRP plus LLLT; (2) ERL plus SRP; (3) SRP plus LLLT; and (4) SRP. We assessed periodontal indexes, including probing depth (PD), clinical attachment level (CAL), bleeding index (BI), and plaque index (PLI), along with three cytokines (IL-1β, TNF-α, IL-10) from gingival crevicular fluid and red complex pathogens from subgingival dental plaque at baseline, 3 months, and 6 months. For initial moderate pockets (4mm≤PD≤6mm), quadrants treated with ERL+SRP+LLLT, ERL+SRP, and SRP+LLLT exhibited greater PD improvement compared to the control (SRP) quadrants at the 3-month follow-up (1.25±1.06, 1.23±1.12, 1.00±1.21vs. 0.98±1.21mm) and the 6-month follow-up (1.35±1.06, 1.23±1.17, 1.35±0.98vs. 0.98±1.23mm) (p=0.002). Quadrants treated with ERL+SRP+LLLT and SRP+LLLT showed more CAL gain means than the control quadrants at the 3-month follow-up (0.96±1.42, 0.61±1.39vs. 0.55±1.57mm) and the 6-month follow-up (0.84±1.54, 0.89±1.49vs. 0.48±1.68mm) (p=0.008). For initial deep pockets (PD≥7mm), the ERL+SRP+LLLT quadrants had more PD improvement and CAL gain compared to the control quadrants at follow-up. There were no significant differences in BI, PLI, inflammatory cytokines, and periodontal pathogens among the four groups. The combined application of ERL and LLLT demonstrated potential efficacy in reducing PD, particularly for deep pockets. To compare the therapy effect of combined use of Er:YAG laser (ERL) and low level laser therapy (LLLT) with single laser applications, and traditional periodontal treatment (SRP). A total of 25 nonsmoking patients with periodontitis were involved, and their mouths were divided into four sections, each receiving a different treatment: ERL+SRP+LLLT, ERL+SRP, SRP+LLLT, and SRP. Clinical indexes and laboratory indicators were assessed at baseline, 3 months, and 6 months. After six months, for initial moderate pockets, combined laser group and single laser group showed better improvements than traditional group in reducing the depth of periodontal pockets and increasing attachment levels. But for initial deep pockets, only combined laser group showed better improvement than traditional group. There were no significant differences in bleeding, plaque, inflammation, or harmful bacterial levels among the groups. These findings suggest that the integration of Er:YAG laser and lowlevel laser therapy into standard periodontal treatment may enhance the treatment's benefits in reducing pocket depth, especially for severe conditions.

Natural compound phloretin restores periodontal immune homeostasis via HIF-1α-regulated PI3K/Akt and glycolysis in macrophages

Periodontitis is a chronic inflammatory disease that affects about 45 %-50 % of adults worldwide, but the efficacy of current clinical therapies is unsatisfactory due to the complicated periodontal immune microenvironment. Thus, developing drugs that can regulate innate immune cells (e.g., macrophages) is a potent strategy to treat periodontitis. Here, we report that phloretin, a food plant-derived natural compound, is sufficient to alleviate periodontitis through immune regulation. In vivo, phloretin treatment could significantly reduce alveolar bone resorption and periodontal inflammation in mouse periodontitis models. In vitro, phloretin could suppress proinflammatory (M1-like) polarization and cytokine release in macrophages induced by LPS. Mechanistically, the immune regulatory role of phloretin in macrophages may be due to its metabolic regulation effect. Phloretin might restore the balance of M1/M2 macrophage transition in periodontitis by inhibiting HIF-1α-mediated glycolysis and PI3k/Akt pathways, thereby reducing the proinflammatory effect and immune disorder caused by over-activated M1 macrophages. Together, this study highlights that natural compound, such as phloretin, can restore periodontal immune homeostasis by metabolic regulation of macrophages, which may provide novel insight into the treatment of periodontitis.

Investigation of the mechanism of baicalein in the treatment of periodontitis based on network pharmacology, molecular docking and experimental validation

PurposeTo verify the effect and mechanism of baicalein in the treatment of periodontitis through network pharmacology, molecular docking and in vitro experiments.MethodsFirstly, multiple databases were used to predict targets of baicalein and periodontitis. And the screened key target genes of baicalein for treating periodontitis were subjected to GO and KEGG analysis; then these targets were analyzed by molecular docking techniques. In vitro experiments including CCK-8, RT-qPCR, ELISA and Immunofluorescence were conducted to validate the efficacy of baicalein in treating periodontitis.ResultsSeventeen key targets were screened from the databases, GO and KEGG analysis of these targets revealed that baicalein may exert therapeutic effects through regulating TNF, PI3K-Akt, HIF-1 and other signaling pathways. Molecular docking analysis showed that baicalein has good binding potential to several targets. In vitro cellular assays showed that baicalein inhibited the expression of TNF-α, MMP-9, IL-6 and MCP1 in P.g-LPS-induced macrophages at both the mRNA and protein level. And the immunofluorescence intensity of iNOS, a marker of M1 type macrophages, which mainly secretes inflammatory factors, was significantly reduced.ConclusionBaicalein has the characteristics and advantages of “multicomponent, multitarget, and multipathway” in the treatment of periodontitis. In vitro cellular assays further confirmed the inhibitory effect of baicalein on the secretion of inflammatory factors of macrophages in periodontitis models, providing a theoretical basis for further study of the material basis and molecular mechanism of baicalein in the treatment of periodontal diseases.

Metronidazole Modified-Release Therapy Using Two Different Polymeric Systems Gels or Films: Clinical Study for the Treatment of Periodontitis.

This study evaluated the efficacy of semisolid systems (gels) and films containing a combination of metronidazole (MTZ) and metronidazole benzoate after scaling and root-planing (SRP) for periodontitis. In total, 45 patients with stage I or II periodontitis were enrolled and divided into 3 groups: 1-SRP-control; 2-SRP + Film with MTZ; 3-SRP + Gel with MTZ. The pH of gingival crevicular fluid (GCF) before/after treatments, MTZ concentrations, and drug release using high-performance liquid chromatography were investigated. The effects were evaluated by longitudinal monitoring of clinical parameters (probing depth-PD, clinical attachment level-CAL, and bleeding on probing-BP). MTZ and MTZ-benzoate concentrations in the periodontal pocket and pH showed no statistical difference after application. SRP + Gel presented the lowest CAL values. For SRP + Film and SRP + Gel, higher PD values were observed at T0 compared to all groups. A relevant reduction in BP was observed in SRP + Film and SRP + Gel groups at all times compared to T0. Both therapies improved periodontal health compared to SRP alone, reducing PD and BP, and increasing CAL for the gel group, suggesting they are promising for periodontal disease treatment.

In situ oxygen-generating bio-heterojunctions for enhanced anti-bacterial treatment of anaerobe-induced periodontitis

Periodontitis, a chronic inflammatory condition associated with bacterial infection, is the leading cause of tooth loss in adults. Pathogenic bacteria that persist in deep periodontal pockets with hyperglycemic levels following traditional manual debridement can contribute to a persistent local inflammatory microenvironment, posing a significant challenge and highlighting the critical need for improved therapeutic approaches. In addition, the anaerobic environment during these treatments is beneficial to the colonization of anaerobes and may amplify inflammatory responses. Herein, we designed a glucose oxidase (GOx)-coating MXene-SnS2 bio-heterojunctions (MS@G bio-HJs) for multi-modal and effective treatment of anti-bacteria and anti-inflammatory. Upon the hyperglycemic nidus in periodontal pockets, GOx catalyzes the conversion of glucose into hydrogen peroxide (H2O2). Subsequently, the breakdown of H2O2 into hydroxyl radicals through Sn2+/Sn4+-involved Fenton-like reactions enables in situ liberation of oxygen (O2), contributing to relieve local hypoxia. The proposed bio-HJs presents a satisfactory bactericidal capability with anti-bacterial rates of more than 99 % upon near-infrared irradiation, in virtue of multi-modal therapies including photodynamic, photothermal and chemodynamic treatments. Furthermore, in vivo assays utilizing infectious rat models demonstrated that the proposed bio-HJs exhibits high biocompatibility and capacity to alleviate hypoxia and reduce pathogenic virulence factors, potentially contributing to periodontal tissue regeneration. These findings suggest that the versatile bio-HJs could be a promising therapeutic candidate for treating infectious periodontal diseases.

Specifying a target trial protocol to estimate the effect of preconception treatment of periodontitis on time-to-pregnancy: A commentary and applied example.

The target trial framework was developed as a strategy to design and analyze observational epidemiologic studies with the aim of reducing bias due to analytic decisions. It involves designing a hypothetical randomized trial to answer a question of interest and systematically considering how to use observational data to emulate each trial component. The primary aim of this paper is to provide a detailed example of the application of the target trial framework to a research question in oral epidemiology. We describe the development of a hypothetical target trial and emulation protocol to evaluate the effect of preconception periodontitis treatment on time-to-pregnancy. We leverage data from Pregnancy Study Online (PRESTO), a preconception cohort, to ground our example in existing observational data. We discuss the decision-making process for each trial component, as well as limitations encountered. Our target trial application revealed data limitations that precluded us from carrying out the proposed emulation. Implications for data quality are discussed and we provide recommendations for researchers interested in conducting trial emulations in the field of oral epidemiology. The target trial framework has the potential to improve the validity of observational research in oral health, when properly applied. We encourage the broad adoption of the target trial framework to the field of observational oral health research and demonstrate its value as a tool to identify directions for future research.

NIR-II triggered Cu(I) phosphide for chemodynamic and photothermal periodontitis treatment: Efficient reduction of bacterial co-aggregation

The synergy between chemodynamic therapy (CDT) and photothermal therapy (PTT) offers a promising antimicrobial strategy for periodontitis, yet faces challenges like complex material structure and limited NIR-I light penetration. Additionally, low endogenous H2O2 levels in biofilm and a focus on bacterial eradication over colonization prevention limit current treatments. To address these issues, we newly introduce a single-material system (Cu3P@PAH@Lox) that integrates dual functionalities to synergistically enhance antimicrobial effects and significantly reduce pathogen co-aggregation. This system utilizes PTT to increase local temperature, boosting •OH production in CDT while downregulating heat shock proteins to enhance PTT efficacy, forming a self-reinforcing feedback loop. Lactate oxidase (Lox) is employed to convert lactate—a metabolite in periodontal biofilm—into H2O2, further amplifying CDT's potential. In vitro Cu3P@PAH@Lox demonstrates a remarkable synergistic effect against dual-species biofilms by more than 2-log reduction of colony-forming unit. Moreover, Cu3P@PAH@Lox exhibits outstanding synergistic antibacterial performances to alleviate inflammation and destruction of tissue in vivo periodontitis model. Furthermore, the mechanism of pathogen co-aggregation disruption by PTT is verified via the Cbe-Ltp1-Ptk1-fimA signaling pathway. This single-material multimodal system we have herein demonstrated for the first time marks a significant advancement in periodontitis treatment, eradicating microbes and preventing bacterial colonization, offering a path to comprehensive periodontal care. Statement of significanceThe synergy between chemodynamic therapy (CDT) and photothermal therapy (PTT) has been considered a promising therapy for periodontitis. Yet, facing challenges, the complex material structure, limited NIR-I light penetration, low endogenous H2O2 level in biofilm, and a focus on bacterial eradication over colonization prevention are still insufficient. This study pioneers a unique, single-material system (Cu3P@PAH@Lox) that synergistically enhances antimicrobial effects and substantially curtails pathogen co-aggregation, advancing periodontitis therapy. By exploiting PTT to elevate local temperatures, thereby increasing hydroxyl radical production in CDT and concurrently suppressing heat shock proteins, the system establishes a potent, self-enhancing loop. Furthermore, lactate oxidase is innovatively utilized to convert lactate from periodontal biofilm into hydrogen peroxide, augmenting the efficacy of CDT. The introduction of Cu3P@PAH@Lox is poised to revolutionize periodontitis treatment, eliminating microbes and impeding bacterial colonization, thereby charting a course for comprehensive periodontal management.