Nonsurgical and surgical treatment of periodontitis: how many options for one disease?

A narrative review on the role of adipose-derived stem cells in periodontal regeneration

OBJECTIVES

Recent research suggests that periodontal regeneration (PR) through the application of adipose-derived stem cells (ADSCs) has depicted some encouraging outcomes. They have the benefit of convenient access and are harvested through minimally invasive and inexpensive procedures. This review aimed to explore the role of ADSCs in PR.

DATA AND SOURCES

The recommendation from the Scale for the Assessment of Narrative Review Articles (SANRA) was utilised to conduct this review. It was carried out by extensively searching the literature for evidence on PR using ADSCs by electronic search through PubMed and Google Scholar databases.

STUDY SELECTION

The search terms included "adipose-derived stem cells" OR "ADSCs" AND "periodontal regeneration" OR "alveolar bone regeneration". A literature review was established to include articles related to the use of ADSCs in PR, after refining the inclusion criteria.

CONCLUSION

The relevant studies demonstrated that ADSCs have a significant regenerative and therapeutic potential in periodontal tissues. Specifically, ADSCs were shown to differentiate into periodontal structures. However, the data is scarce for assessing their effectiveness in human models. Consequently, further research is required, including randomised controlled trials on human and animal models to further verify their regenerative capability in periodontal restoration.

CLINICAL SIGNIFICANCE

Adipose-derived stem cells exhibited their capability to differentiate into key periodontal structures and enhance tissue repair indicating their potential as a novel therapeutic method for improving clinical results in periodontal treatment.

Gallic acid promotes M2 macrophage polarization through mitochondrial oxidative phosphorylation in periodontitis

OBJECTIVE

This in vitro investigation assessed the role of gallic acid in regulating macrophage polarization.

DESIGN

In this study, RAW264.7 macrophages were treated with P. gingivalis lipopolysaccharide (LPS) to mimic inflammatory conditions in periodontitis. Immunofluorescence staining, enzyme‑linked immunosorbent (ELISA) assay, RNA sequencing, and seahorse metabolic profile assay were used to assess the effects of gallic acid on macrophage polarization, cytokine release, underlying mechanism and metabolic profile.

RESULTS

The study demonstrated that treatment with gallic acid could induce M2 polarization of macrophages (P < 0.01) and increase the production of anti-inflammatory cytokines (P < 0.01). Analysis of RNA sequencing data showed enrichment of mitochondrial oxidative phosphorylation, regulation of metabolic processes, and the PI3K-Akt signaling pathway in LPS-treated macrophages treated with gallic acid. Furthermore, gallic acid was found to enhance mitochondrial oxidative phosphorylation activity through the PI3K-Akt signaling pathway in RAW264.7 cells.

CONCLUSIONS

Gallic acid treatment has the potential to promote M2 polarization of macrophages by modulating mitochondrial oxidative phosphorylation via the PI3K-Akt signaling pathway.

Macrophage membrane functionalized composite microspheres promote bone regeneration in periodontitis via manipulating inflammation reversing-osteogenesis coupling

Periodontitis is characterized by inflammation and alveolar bone loss, primarily caused by immune cells activated by oral bacteria, leading to an imbalance between osteogenesis and bone resorption. Traditional treatments have limited efficacy, which has led to the exploration of regulating the immune microenvironment and utilizing tissue engineering methods as new research directions. Our study demonstrates that macrophage membranes, activated by LPS and IFN-γ, can effectively neutralize inflammatory factors. By coating the poly-L-lysine (PLL) modified poly (lactic-co-glycolic acid) (PLGA)/β-TCP microspheres with such macrophage membrane vesicles, the MM@PPT microspheres regulate intercellular responses by inhibiting macrophage M1 polarization and osteoclast differentiation, promoting M2 polarization, and enhancing osteogenic differentiation of bone marrow stromal cells (BMSCs) even in an inflammatory environment. By injecting the MM@PPT into sites of periodontitis induced bone resorption, it is found that they can effectively promote bone regeneration by modulating the immune-regeneration microenvironment. This work not only highlights the potential of MM@PPT microspheres in promoting alveolar bone regeneration but also provides insights into how these microspheres modulate cell behavior and interactions. The findings of this study offer novel therapeutic strategies for promoting alveolar bone repair in periodontitis.

METTL3 Promotes Osteogenic Differentiation of Human Periodontal Ligament Stem Cells Under the Inflammatory Microenvironment Through the miR-141-3p/ZEB1 Axis

Periodontitis, a chronic inflammatory condition, often results in gum tissue damage and can lead to tooth loss. This study explores the role of methyltransferase-like 3 (METTL3) in promoting osteogenic differentiation of human periodontal ligament stem cells (hPDLSCs) within an inflammatory microenvironment. An inflammatory environment was simulated in hPDLSCs using lipopolysaccharide (LPS). Both adipogenic and osteogenic differentiation capacities of hPDLSCs were assessed. In LPS-treated hPDLSCs, METTL3 was overexpressed, and alkaline phosphatase (ALP) staining was performed alongside measurements of ALP activity, pro-inflammatory cytokines, METTL3, miR-141-3p, pri-miR-141, Zinc finger E-box binding homeobox 1 (ZEB1), runt-related transcription factor 2 (RUNX2), osteocalcin (OCN). N6-methyladenosine (m6A) and pri-miR-141 levels were quantified, and the binding of miR-141-3p to ZEB1 was analyzed. The results demonstrated that osteogenic differentiation in hPDLSCs was diminished under inflammatory conditions, coinciding with downregulated METTL3 expression. However, METTL3 overexpression enhanced osteogenic differentiation. METTL3 facilitated the conversion of pri-miR-141 into miR-141-3p via m6A modification, resulting in increased miR-141-3p levels, which in turn suppressed ZEB1 expression. Inhibition of miR-141-3p or overexpression of ZEB1 partially counteracted the positive effects of METTL3 on osteogenic differentiation. In conclusion, these findings suggest that METTL3-mediated m6A modification promotes osteogenic differentiation of hPDLSCs within an inflammatory microenvironment through the miR-141-3p/ZEB1 axis.

Exploration of Liuwei Dihuang Pill on periodontitis based on network pharmacology and molecular docking

This study explores the mechanism of Liuwei Dihuang Pill (LWDHP) in the treatment of periodontitis using network pharmacology and molecular docking. The active ingredients and targets of LWDHP were obtained from databases such as Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform. Databases such as GeneCards, OMIM, and DisGeNET were used to obtain the relevant targets related to periodontitis. The intersection of these 2 groups of targets was taken and imported into STRING to facilitate the acquisition of protein-protein interaction data, which was then imported into Cytoscape 3.10.2 to perform topological analysis to obtain the core targets. Gene ontology and Kyoto encyclopedia of genes and genomes bioinformatics enrichment analyses of the intersecting targets were performed using the DAVID database. Validation of molecular docking matching between key active ingredients with top 5 degree values and key targets with top 5 degree values in the treatment of periodontitis with LWDHP using AutoDockTools-1.5.6. A total of 69 active ingredients were discerned in LWDHP, implicating 198 periodontitis-relevant targets. Thirty-four core targets were obtained by protein-protein interaction network topology analysis, among which the key targets with the top 5 values of degree were tumor necrosis factor (TNF), serine/threonine protein kinase AKT1, sarcoma, epidermal growth factor receptor, and matrix metallopeptidase 9. Topological analysis revealed that the key active ingredients with the top 5 values of degree in LWDHP were Polyporenic acid C, Alisol B, Hydroxygenkwanin, Denudatin B, and Kadsurenone. The molecular docking results demonstrated that the binding energies of the above molecules with targets were all <-5 kcal/mol, indicating a good binding ability between these molecules. The gene ontology enrichment results indicated that the treatment of periodontitis by LWDHP was mainly related to the inflammatory response, positive regulation of phosphatidylinositol-3-kinase-Akt (PI3K-Akt) signal transduction and other processes. Analysis of the Kyoto encyclopedia of genes and genomes signaling pathway showed that the TNF signaling pathway, the PI3K-Akt signaling pathway, and so on are important signaling pathways. In conclusion, the mechanism of action of LWDHP in the treatment of periodontitis is characterized by multicomponents, multi-targets, and multi-pathways. TNF, serine/threonine protein kinase AKT1, sarcoma, epidermal growth factor receptor, and matrix metallopeptidase 9 are the key targets and the TNF signaling pathway, the PI3K-Akt signaling pathway are the key pathways. LWDHP treats periodontitis through actions such as anti-inflammatory and regulation of the balance between osteogenesis and bone destruction.

Invisible appliance promotes bone reconstruction via modulating the periodontal immune microenvironment

OBJECTIVES

Recently, invisible appliances have become popular due to their aesthetics and comfort, but their impact on periodontal health in periodontitis patients has not been fully elucidated. The purpose of this study was to investigate the effectiveness of fixed and invisible appliance treatment for periodontitis in experimental rats while monitoring the dynamics of Th17/Treg cells and osteoclast-related cytokines during treatment.

METHODS

SD rats were randomly divided into six groups: control, periodontitis model, scaling-0 (basic treatment), no appliance, fixed appliance, and invisible appliance. After successful establishment of ligature-induced periodontitis, rats in the treatment groups were first subjected to supra/subgingival scaling and daily brushing for 2 weeks. Next, except rats in the scaling-0 group, the periodontitis rats were treated with uncorrected, fixed, or invisible appliance, respectively. The CEJ-AC was examined using micro-CT. Osteoclast activation was detected with TRAP staining. The proportion of Th17 and Treg cells was measured by flow cytometry. Subsequently, potential mechanisms were explored by detection of RORγt, Foxp3, RANKL, OPG, and pathogenic bacteria (Pg, Aa, and Tf). Finally, the association between Th17/Treg cells and osteoclast-related indicators as well as pathogenic bacteria was evaluated by correlation analysis.

RESULTS

Among the three treatments, invisible appliance treatment provided optimal results in controlling periodontal infection while promoting periodontal tissue repair. Specifically, in the early phase of treatment (3-7 days), orthodontic force exerted by the appliance stimulates osteoclast and Th17 cell activation by increasing RANKL and RORγt expression, thereby inducing osteoclast generation and accelerating the amount of tooth movement. In the later stages of treatment (7-21 days), Foxp3 and OPG levels gradually increased to induce the dominant role of Treg cells, controlling osteoclast generation and bone resorption. Meanwhile, the invisible appliance can maintain a low number of pathogenic bacteria during treatment. Finally, Th17 cells showed significant positive correlation with RANKL, Pg, osteoclast percentage, and CEJ-AC; Treg cells were positively correlated with RANKL and OPG; Th17/Treg ratio displayed positive correlation with RANKL/OPG or osteoclast percentage.

CONCLUSIONS

Invisible appliance has obvious advantages in periodontitis treatment, which can effectively improve periodontal condition and reduce inflammatory response.

Advances in harnessing biological macromolecules for periodontal tissue regeneration: A review

Periodontitis is a chronic multifactorial inflammatory oral disease that can lead to gingival recession, destruction of the periodontal ligament, alveolar bone loss, and tooth loss. Solutions for periodontal tissue regeneration utilize biological macromolecules, including natural ones (such as collagen (COL), alginate (ALG), chitosan (CS), silk fibroin (SF), hyaluronic acid (HA), etc.), inorganic ones (such as hydroxyapatite (HAp), β-tricalcium phosphate (β-TCP), bioactive glass (BG), etc.), synthetic, composite, and nanomaterials. Carrier materials, including hydrogels, nanofibers, nanoparticles, microneedles, and thin films, are used to effectively deliver therapeutic agents and biological factors such as stem cells, bioactive molecules, and genes, so as to promote the elimination of bacteria and tissue regeneration at the damaged periodontal sites. This review mainly focuses on the latest progress of biological macromolecules and tissue engineering technologies in periodontal regeneration in recent years. It aims to inspire the design and development of innovative biomaterials and delivery systems for novel regenerative periodontal treatments.

Scientific Research Trend on Guided Tissue Regeneration: A Bibliometric Analysis

OBJECTIVES

 Guided tissue regeneration (GTR) is a widely used technique in contemporary dentistry which helps achieve regeneration of periodontal tissues. This study aims to identify leading countries, authors, institutes, journals, scientific publications, and mostly used keyword regarding role of GTR in treatment for periodontal disease using the Scopus database.

MATERIALS AND METHODS

 A well-curated search through Scopus database for significant literature related to GTR published between 1987 and 2023 was performed. Bibliographical data which comprised of abstracts, title, keywords, references, citations, and other relevant information were composed. The data was analyzed using MS Excel and VOSviewer.

RESULTS

 Scientific literature on GTR was manually scrutinized, and 308 paper were analyzed using the Scopus database. The first paper on GTR was published in 1987. Journal of Periodontology was identified as the leading journal, while the United States and Italy were the top contributing countries. University of Sienna was the most productive organization. Roberto Pontoriero was identified as the highly cited author. A highly cited scientific paper was published by Pintippa Bunyaratavej in 2001.

CONCLUSION

 The present bibliometric study gives useful information related to the total number of scientific articles published from 1987 to 2023. A rising trend of scientific publication was identified which continued followed by a notable decline after 2004. The analysis also recognized the United States and University of Sienna, from Italy as most active country and organizations, while the Journal of Periodontology as the leading journal.

CLINICAL RELEVANCE

 This study may assist in continuing education and evidence-based practice for clinicians and new researchers by providing knowledge and aiding literature searches in the domain of GTR used in treatment for periodontal conditions.

Engineered Macrophage Membrane-Camouflaged Nanodecoys Reshape the Infectious Microenvironment for Efficient Periodontitis Treatment

A vicious cycle between microbiota dysbiosis and hyperactivated inflammation, hardly disrupted by conventional therapies, remains a significant clinical challenge for periodontitis treatment. Herein, by cloaking a cascade catalysis system in an engineered macrophage membrane, a nanodecoy-based strategy, with targeted bacteria-killing and immunomodulatory abilities, is proposed for reshaping the hostile periodontitis microenvironment. Specifically, recombinant human antimicrobial peptide, LL-37, is anchored to a Toll-like receptor-enriched macrophage membrane via genetic engineering, which facilitates the specific bacteria elimination and efficient tissue retention of the nanodecoys. Moreover, the cascade catalysis system integrates L-amino acid oxidase (LAAO) with hollowed manganese dioxide (hMnO2) by reciprocal elevation of the catalytic efficiency of hMnO2 and LAAO, leading to accelerated O2 generation under a hypoxic microenvironment and disrupted metabolism of periodontopathogenic bacteria. Notably, the nanodecoys trigger the nuclear translocation of NF-E2-related factor-2 (NRF2) to reduce oxidative stress response and rewire the polarization of macrophages, thereby boosting the osteogenic differentiation of osteoblasts. Furthermore, the alveolar bone regeneration therapeutically benefits from the nanodecoys in vivo. Altogether, these results highlight the attractive functions of engineered macrophage membrane-cloaked nanodecoys for effective periodontitis treatment.

Development of an artificial intelligence model for optimizing periodontal therapy decision-making: a retrospective longitudinal cohort study

OBJECTIVES

This study aims to develop and validate an artificial intelligence (AI) - driven model to assist periodontal therapy decision-making and minimize tooth loss.

METHODS

A retrospective longitudinal cohort study was conducted using clinical and radiographic data from 3,347 teeth treated and followed up for at least 10 years. The parameters included in the machine learning training and testing processes included: probing pocket depth (PPD), bone loss (BL), systemic diseases, therapy type, and others. Various machine learning models were developed and evaluated for accuracy, precision, recall, F1-score, and Area Under the Receiver Operating Characteristic Curve (AUC-ROC).

RESULTS

The Random Forest model demonstrated superior performance and was selected as the final predictive model achieving an AUC score of 0.91 and an accuracy of 0.93. Significant associations were found between tooth loss and variables such as age, PPD, bone loss, and furcation involvement.

CONCLUSION

This AI-driven platform may provide a reliable tool for stratifying periodontal therapy decisions and predicting tooth loss risk, offering clinicians a supportive approach to personalize treatment plans. However, the study's retrospective design and reliance on traditional clinical metrics highlight the need for future prospective studies.

CLINICAL SIGNIFICANCE

This study introduces and validates a novel AI-driven predictive model for periodontal therapy, utilizing data from treatment cases. Unlike previous models, this approach integrates multiple clinical and radiographic parameters, demonstrating high predictive accuracy (AUC=0.91, accuracy=0.93). The use of the Random Forest algorithm allows for robust predictions, offering an innovative, data-driven approach to periodontal treatment planning. Implementing AI in periodontal therapy decision-making may have the potential to improve patient outcomes by guiding clinicians toward optimal treatment strategies, enhancing therapeutic precision, and reducing the likelihood of unnecessary interventions.

Immunomodulatory peptide DP7-C mediates macrophage-derived exosomal miR-21b to promote bone regeneration via the SOCS1/JAK2/STAT3 axis

Periodontitis, the most prevalent chronic inflammatory disease leading to bone resorption, presents significant challenges for achieving optimal periodontal bone regeneration and repair despite efforts to reduce inflammation and stimulate osteogenesis. Macrophage-derived exosomes have emerged as promising therapeutic agents due to their osteogenic and immunomodulatory potential. Specific stimulation of macrophages can alter the exosomal composition, particularly microRNAs (miRNAs), thereby altering their functions. DP7-C, a cationic immunomodulatory peptide, is known to regulate immune responses and cellular processes by interacting with cell membranes and signaling pathways. However, its effects on macrophage exosomal miRNA profiles remain poorly understood. In this study, we identified differential miRNA expression in macrophage-derived exosomes following DP7-C stimulation, with a notable upregulation of miR-21b. To investigate the osteogenic role of exosomal miR-21b, DP7-C was utilized to facilitate the transfection of miR-21b into macrophages, leading to the secretion of exosomes enriched with miR-21b. These exosomes enhanced osteogenic differentiation in vitro and alleviated periodontal tissue damage in an experimental periodontitis model in vivo. Mechanistically, exosomal miR-21b promotes osteogenesis by directly targeting the suppressor of cytokine signaling (SOCS1), thereby activating the JAK2/STAT3 signaling pathway. This study establishes macrophage-derived exosomal miR-21b as a potent catalyst for bone regeneration, highlighting a promising acellular therapeutic strategy for periodontitis.

Regeneration of Two-Walled Infrabony Periodontal Defects in Swine After Buccal Fat Pad-Derived Dedifferentiated Fat Cell Autologous Transplantation

Mature adipocyte-derived dedifferentiated fat (DFAT) cells show proliferative capabilities and multipotency. Given that the buccal fat pad (BFP) serves as a readily available resource for DFAT cell isolation, BFP-derived DFAT (BFP-DFAT) cells are a promising candidate in orofacial tissue engineering. In this research, we assessed the regenerative capacity of the periodontium through autologous BFP-DFAT cell transplantation in adult swine (micro-minipigs; MMPs). The BFP-DFAT cells were transplanted into inflammation-inducing two-walled infrabony periodontal defects located on the mesial of the second mandibular premolar (n = 6). Twelve weeks post-transplantation, a remarkable attachment gain was noted in the DFAT group, based on probing depths and clinical attachment levels. Histological and immunohistochemical analyses indicated new continuous cellular cementum and alveolar bone formation within the created infrabony defect. Well-organized periodontal ligament-like fibers were embedded between newly formed cementum and the alveolar bone. Histometric analysis demonstrated that the DFAT group had a 2.2-fold increase in new alveolar bone length and a 2.2-fold enhancement in vascularization than those in the control group. Except for minor inflammation in the lungs, no teratomas were detected in the recipient MMPs. BFP-DFAT cells significantly enhanced periodontal tissue regeneration, thus representing an optimal source for tissue engineering applications in dentistry.

Clinical efficacy of adjunctive use of coenzyme Q10 in non-surgical periodontal treatment: A systematic review

This systematic review evaluated the effects of coenzyme Q10 (CoQ10) in non-surgical periodontal treatment (PROSPERO: CRD42022311286). Five databases were screened (up to May/2024). It included only randomized controlled trials (RCTs) of subgingival scaling root planing (SRP) with or without adjunct use of the antioxidant CoQ10 in adults with periodontitis. The risk of bias and the certainty of the evidence were assessed. Meta-analyses were conducted to estimate mean differences for probing depth (PD) and clinical attachment level (CAL) between baseline and follow-up. Ten studies were included, of which four administered CoQ10 locally (topical [n = 1]; intra-pocket [n = 3] modalities), and six used oral supplementation. There was no significant effect of local use of CoQ10 on reduction of PD and gain in CAL. Daily oral supplementation (120 mg/day) with CoQ10 resulted in a greater mean reduction of PD by 0.41 mm (95% CI: 0.02-0.80) and a greater mean CAL gain by 0.52 mm (95% CI: 0.26-0.78) than seen in controls. Based on very low certainty of evidence, there was no significant effect of locally delivered Q10 gel on PD/CAL, but daily oral supplementation with CoQ10 resulted in better periodontal health after 12 weeks.

Methods used to deliver adjunctive probiotic treatment during the non-surgical management of periodontitis: A scoping review

OBJECTIVE

To identify which methods have been used to deliver adjunctive probiotics during the non-surgical management of periodontitis in clinical trials. This review also investigates which probiotics have been used and at what dose, along with the periodontal treatment outcomes achieved.

DATA

Conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews.

SOURCES

MEDLINE, Embase, Web of Science, and Scopus were searched on 02/02/2024 from inception with no date limits applied.

STUDY SELECTION

Clinical trials investigating the use of probiotics as an adjunctive treatment to non-surgical periodontal therapy in humans.

CONCLUSIONS

Out of 4769 studies 66 met the inclusion criteria. Over 30 different probiotics were identified along with 18 different delivery methods with varying dosages and duration. 48 of the included studies reported a beneficial effect when a probiotic was used, 14 reported no difference, 3 found the outcomes comparable to the use of antibiotics, and 1 study reported a better outcome from the control group. The probiotic used, its dosage, delivery method, duration of application, and outcome measures differ across studies making it difficult to draw conclusions on their efficacy. This scoping review highlights the need for further research to establish a uniform treatment protocol and to identify the most effective probiotic bacteria.

CLINICAL SIGNIFICANCE

Despite the majority of included studies indicating a potential benefit from the use of probiotics during the non-surgical management of periodontitis, the high level of heterogeneity between interventions they currently cannot be recommended for use in clinical practice.

Elongation factor Tu promotes the onset of periodontitis through mediating bacteria adhesion

Periodontitis, a leading cause of adult tooth loss and linked to various systemic diseases, is promoted by subgingival plaque biofilms, with Streptococci as early colonizers responsible for surface adhesion. Current studies of Streptococci adhesion have focused on bacteria surface adhesins with acquired protein membranes on the tooth surface, yet no critical proteins with implications for the overall early adhesion of subgingival plaque have been reported. Here, we identified that the "Barrel-like adhesion domain" of streptococcal EF-Tu facilitates cell-surface attachment, promotes biofilm formation, and contributes to the development of periodontitis. In the adherent state, EF-Tu is transported from the cytoplasm to the cell surface through membrane vesicles. Furthermore, we first found that simeprevir, an FDA-approved drug, binds to the "Barrel-like adhesion domain" of EF-Tu and effectively inhibits the protein's surface adhesion and secretory pathways. Simeprevir showed the ability to inhibit dental plaque formation and provided prevention and treatments for periodontitis.

Identification of key genes in periodontitis

Periodontitis, a prevalent global oral health issue, is primarily characterized by chronic inflammation resulting from bacterial infection. Periodontitis primarily affects the tissues surrounding and supporting the teeth, encompassing the gingival tissue, periodontal attachment apparatus, and the bony socket. The disease mechanism results from intricate interactions between hereditary factors, the body's defense mechanisms, and shifts in the composition of oral microbiota, with each element playing a crucial role in the initiation and advancement of the pathological process. The early symptoms of periodontitis are often not obvious, resulting in patients often not seeking medical attention until they are seriously ill, so finding biomarkers for periodontitis is essential for timely diagnosis and treatment. In this study, we selected two datasets (GSE10334 and GSE16134) by in-depth analysis of publicly available sequencing data of affected and unaffected gum tissue in periodontitis patients in the GEO database. To identify key genes associated with periodontitis pathogenesis and explore potential therapeutic biomarkers, we employed two complementary computational approaches: Random Forest, a robust machine learning algorithm for feature selection, and Weighted Gene Co-expression Network Analysis (WGCNA), a systems biology method for identifying co-expressed gene modules. Through comprehensive analysis of these combined datasets, our objective is to elucidate the underlying molecular pathways governing periodontal disease progression, thereby identifying novel therapeutic targets that may facilitate the design of improved clinical interventions for this condition. This study establishes a substantial scientific foundation that contributes to both clinical applications and fundamental research in periodontitis. The findings not only offer valuable insights for developing early diagnostic strategies and therapeutic interventions but also provide a robust theoretical framework to guide future investigations into the molecular mechanisms underlying this complex disease.

Correlation of the oral health and biochemical profile in hemodialysis patients with end-stage renal diseases

The current study aims to investigate the oral health of end-stage renal diseases (ESRD) patients undergoing hemodialysis and to correlate it with the biochemical profile of the patients. The current study included 43 ESRD patients on regular hemodialysis. The oral hygiene status, dental, and periodontal health were measured by the following indices: decayed, missed, and filled teeth (DMFT) index, visible plaque index (VPI), and Russell periodontal index (RPI). Several biochemical, hormonal, and hematological parameters were evaluated for each patient. The correlation of the oral health status with the biochemical profile of the patients was measured. The mean age of the participants in the current study was (51.67 ± 14.7) years. About 81% of the participants were hypertensive (35), 19% were diabetic (8), and 28% showed HCV positivity (12). VPI showed 30% of patients had fair oral hygiene and 44% had poor oral hygiene. According to RPI, periodontitis was detected in more than 95% of patients. It was significantly correlated with the age and body mass index (BMI) of the patients. DMFT index was significantly positively correlated to RPI and serum transferrin saturation. RPI scores showed a significant correlation between the ages of the patients and their BMI. VPI significantly correlated with serum calcium, but not with other biochemical variables. ESRD patients treated with hemodialysis showed several oral health concerns. Most of these patients had periodontitis, which was more frequent in diabetics and elderly patients. Advanced grades of periodontitis were associated with older age and increased BMI.

Minocycline-Loaded Titanium Dioxide Nanoparticles for Augmented Synergistic Periodontal Sonodynamic Chemotherapy

Background

The current clinical treatment of periodontitis usually involves mechanical removal of pathogenic bacteria through ultrasonic scaling and root planing, supplemented with antibacterial medications to inhibit microbial overgrowth. However, the therapeutic efficiency remains unsatisfactory due to complicated periodontal anatomy, limited plaque removal, short retention of antibiotics, and related side effects.

Methods and Results

To address these issues, we successfully synthesized mesoporous titanium dioxide nanoparticles (MTN) via a sol-gel method, which were modified with hemoglobin (Hb) and loaded with minocycline (MINO). The resulting Hb-MTN/MINO nanoparticles had a size of 215 nm, zeta potential of -19.8 mV±0.9 mV, and uniform shape with a PDI index of 0.176. The modification with hemoglobin (Hb) provided sufficient oxygen for antimicrobial sonodynamic therapy (aSDT), contributing to improved generation of reactive oxygen species (ROS) under low ultrasound intensity. After MINO loading, the system exhibited notable antibacterial efficacy, with a 6 log reduction of bacterial counts compared to the control group. Hb-MTN/MINO was evaluated in vivo in terms of oral index, soft and hard tissues, along with biosafety evaluation in periodontal disease model rats. Hb-MTN/MINO demonstrated a satisfactory therapeutic effect, whereby the periodontal condition of the rats exhibited a greater improvement than the control group, and measurement of the serum levels of inflammatory factors revealed that both IL-6 and MMP-9 were significantly downregulated.

Conclusion

These findings confirm the potential of Hb-MTN/MINO nanoparticles as a promising treatment option for periodontitis.

Effects of ozone therapy as an adjuvant in the treatment of periodontitis: a systematic review and meta-analysis

BACKGROUND

Chronic periodontitis is an infectious disease initiated by plaque, which affects chewing and even general health. Ozone therapy, as a complementary means in the treatment of chronic periodontitis, numerous clinical trials have been conducted. We conducted this review to evaluate the effect of the ozone use accompanied by scaling and root planning (SRP) in periodontal treatment.

METHODS

Randomized controlled trials investigating the use of ozone therapy in chronic periodontitis. The search was carried out across PubMed, Cochrane Central Register of Controlled Trials, and EMBASE databases with the search period extending to July 2024. The quality of the identified studies was evaluated using the Cochrane Collaboration's Risk of Bias tool. The results were presented as weighted mean differences (WMD) with corresponding 95% confidence intervals (95% CI). Heterogeneity among the studies was assessed using the I2 test. Data analysis was performed using RevMan 5.4 and Stata 16.0.

RESULTS

Thirteen articles meeting the inclusion criteria. The meta-analysis revealed statistically significant differences in probing depth (PD) and gingival index (GI) reduction between ozone-assisted nonsurgical periodontal treatment and placebo-assisted treatment in patients with chronic periodontitis (P < 0.05). However, no significant differences were observed in clinical parameters such as bleeding on probing (BOP) percentage, plaque index (PI), and clinical attachment level (CAL) (P > 0.05).

CONCLUSION

Ozone therapy combined with SRP is superior to SRP alone in improving PD and GI indexes in patients with periodontitis, without increasing adverse reactions, and the effect is worthy of recognition. The research evidence indicates that ozone therapy in patients with chronic periodontitis has a positive effect.

Creatine promotes osteogenic differentiation of dental pulp stem cells via the AMPK-ULK1-autophagy axis

OBJECTIVE

We aimed to demonstrate the effects of creatine (Cr) on osteogenic differentiation (OD) in HDPSCs.

MATERIALS AND METHODS

HDPSCs were treated with Cr and an inhibitor of Cr transporter. The OD capacity was evaluated by detecting ALP staining and activity, alizarin red staining (ARS), as well as osteogenesis-related protein levels. Transcriptomic sequencing, western blotting, transmission electron microscopy, immunofluorescence staining, and autophagy-related protein marker detection were applied to illustrate the underlying mechanism. Furthermore, the impact of Cr on bone regeneration was investigated in vivo.

RESULTS

We found that 1 mm of Cr effectively enhanced the OD of HDPSCs. The creatine group displayed significantly increased AMPK phosphorylation, overexpressed autophagy-related proteins, enhanced OD, and mineralization capabilities. We also found that ULK1 is the downstream molecule through which AMPK induces cellular autophagy. In vivo results demonstrated that Cr could increase the new bone formation of periodontitis.

CONCLUSION

Our research discovered a new AMPK-ULK1-autophagy pathway through which Cr enhances OD in HDPSCs. Cr enhanced HDPSCs-mediated periodontal tissue regeneration in a periodontitis mouse model, providing a theoretical foundation for the study of bone repair in periodontitis.

A Narrative Review of Periodontal Vaccines: Hope or Hype?

Globally, periodontal diseases, mainly driven by polymicrobial biofilms, are a widespread concern of social medicine due to their considerable incidence and tie-up to systemic disorders like diabetes, cardiovascular diseases, and complications during pregnancy. Traditional treatments focus on mechanical debridement and antimicrobial therapies, but these approaches have limitations, including recurrence and antibiotic resistance. Periodontal vaccines offer a promising alternative by targeting the immunological mechanisms underlying periodontal disease. This review explores the current state of periodontal vaccine development, highlighting key antigens, vaccine delivery systems, and preclinical and clinical advancements. Special emphasis is placed on antigen selection, host variability, immune tolerance, and future directions to overcome these barriers. This article highlights the advancements and challenges in periodontal vaccine research, offering insights into the capability of immunoprophylaxis as a groundbreaking way to manage periodontal diseases.

Clinical effectiveness of aloe vera gel as an adjunct to mechanical debridement in patients with periodontitis: A systematic review and meta-analysis

Background

This study aimed to evaluate the clinical effect of aloe vera gel as an adjunct to scaling and root planing (SRP) on plaque index (PI), gingival index (GI), and probing pocket depth (PPD) in periodontitis treatment.

Methods

Randomized controlled trials (RCTs) were included, focusing on aloe vera gel as an adjunct to SRP in periodontitis patients. An extensive literature search was conducted across PubMed, PubMed Central, Scopus, OVID, Google Scholar, and Cochrane Library databases up to October 2024. The risk of bias was assessed using the Revised Cochrane Risk of Bias tool (ROB 2.0), and statistical analysis was performed using Review Manager 5.4.1.

Results

Fifteen RCTs were included in this systematic review, and separate meta-analyses were conducted for each outcome. For PI, the random effects model showed a mean difference (MD) of -0.23 (95% CI: -0.69, 0.23), favoring the experimental group (P=0.33). The fixed effects model for PI favored the control group (MD=0.12; P=0.20). For GI, the random effects model favored the experimental group (MD=-0.28, P=0.01), while the fixed effects model favored the control group (MD=0.17; P<0.001). For PPD, the random effects model favored the experimental group (MD=-0.45, P=0.009).

Conclusion

As an adjunct to SRP, aloe vera gel significantly improved PI, GI, and PPD in periodontitis patients.

Trial registration

PROSPERO ID: CRD42020201315.

Hypoxia-inducible Factor 1α Contributes to Matrix Metalloproteinases 2/9 and Inflammatory Responses in Periodontitis

Periodontitis is a prevalent condition characterized by inflammation and tissue destruction within the periodontium, with hypoxia emerging as a contributing factor to its pathogenesis. Hypoxia-inducible factor 1α (HIF-1α) has a crucial role in orchestrating adaptive responses to hypoxic microenvironments and has been implicated in various inflammatory-related diseases. Understanding the interplay between HIF-1α, matrix metalloproteinases (MMPs), and inflammatory responses in periodontitis could provide insights into its molecular mechanisms. We investigated the relationship between HIF-1α, MMP2, and MMP9 in gingival crevicular fluid (GCF) and periodontal ligament stem cells (PDLSCs) from periodontitis patients. The expression levels of HIF-1α, MMP2, MMP9, and inflammatory factors (IL-6, IL-1β, TNF-α) were assessed using enzyme-linked immunosorbent assay (ELISA) and real-time PCR (RT-PCR). Additionally, osteogenic differentiation of PDLSCs was identified by alkaline phosphatase activity. Significantly elevated levels of HIF-1α, MMP2, and MMP9 were observed in GCF of periodontitis patients compared to controls. Positive correlations were found between HIF-1α and MMP2/MMP9, as well as with IL-6, IL-1β, and TNF-α. Modulation of HIF-1α expression in PDLSCs revealed its involvement in MMP2/9 secretion and inflammatory responses, with inhibition of HIF-1α mitigating these effects. Furthermore, HIF-1α inhibition alleviated the reduction in osteogenic differentiation induced by inflammatory stimuli. Our findings elucidate the regulatory role of HIF-1α in MMP expression, inflammatory responses, and osteogenic differentiation in periodontitis. In conclusion, targeting HIF-1α signaling pathways may offer therapeutic opportunities for managing periodontitis and promoting periodontal tissue regeneration.

Plant and animal-derived fusion nanovesicles rescue inflammation-compromised osteogenic potential of periodontal ligament stem cells

Periodontitis is a chronic inflammatory disease affecting the supporting tissues of the teeth and has emerged as a global public health issue. Current therapies primarily address pathogenic factors and alleviate symptoms, with limited options available for complete restoration and reconstruction of already absorbed periodontal bone tissue. In this study, we developed a nanotherapeutic strategy utilizing fusion nanovesicles (FVs) to modulate the inflammatory microenvironment and create a regenerative niche for periodontal ligament stem cells (PDLSCs), which play a crucial role in periodontal tissue repair. The FVs are composed of Scutellaria baicalensis nanovesicles (SBNVs) with anti-Porphyromonas gingivalis (P. gingivalis) and anti-inflammatory properties, combined with PDLSC membrane-derived nanovesicles genetically engineered to express TNFR1. These FVs preserved the biological activity of SBNVs and the immunomodulatory function of PDLSCs. Additionally, FVs effectively captured and cleared TNF-α from the microenvironment through TNFR1. Moreover, FVs alleviated the inflammatory response of PDLSCs induced by P. gingivalis-LPS (Pg-LPS) and TNF-α, restoring their proliferation, migration, and osteogenic differentiation capabilities. Hence, this nanotherapeutic strategy holds great potential for treating periodontitis.

Low-Speed Platelet-Rich Fibrin Membrane in Conjunction With Demineralized Freeze-Dried Bone Allograft (DFDBA) Compared to Collagen Membrane With DFDBA in Noncontained Intraosseous Defects of Stage III Periodontitis: A Randomized Controlled Clinical Trial

Aim: Noncontained (1- or combined 1- to 2-wall) periodontal intraosseous defects represent challenging clinical situations with unpredictable surgical therapeutic outcomes. This randomized clinical trial assessed demineralized freeze-dried bone allograft (DFDBA) with low speed-platelet-rich fibrin (PRF) membrane compared to DFDBA with collagen membrane (CM) in the surgical periodontal therapy of noncontained intraosseous defects of stage III periodontitis patients. Methodology: Twenty-two stage III periodontitis patients with noncontained intraosseous defects measuring ≥3 mm and clinical attachment loss ≥5 mm were randomly allocated into two groups: test group (low-speed PRF membrane + DFDBA) and control group (CM + DFDBA), with 11 participants per group. Clinical and radiographic assessments were conducted at baseline, 3, 6, 9, and 12 months for clinical attachment level (CAL; primary outcome), gingival recession depth (GRD), probing depth (PD), full mouth bleeding score (FMBS) and full mouth plaque score (FMPS), radiographic bone fill and radiographic linear defect depth (RLDD; all secondary outcomes). Results: The mean (±SD) CAL-gain for the test group was 2.45 (±1.51), 2.91 (±1.70), 2.91 (±1.87), and 2.82 (±1.83) mm, while for the control group 2.82 (±1.25), 3.27 (±1.27), 3.00 (±1.41), and 2.64 (±1.50) mm at 3, 6, 9, and 12 months, respectively, with no significant intergroup differences (p > 0.05). Despite the absence of significant intergroup differences, both groups demonstrated significant intragroup improvement in CAL- and PD-gain, and RLDD-reduction at 3, 6, 9, and 12 months as well as RLDD improvement at 12 months (p < 0.05). Conclusion: PRF membranes, in conjunction with DFDBA, show significant improvement of periodontal clinical and radiographic parameters, comparable to CMs with DFDBA. Trial Registration: ClinicalTrials.gov identifier: NCT03922503.

Effectiveness of the dual wavelength diode laser as an adjunct to non-surgical treatment in treating periodontal pocket in periodontitis patients: A randomized clinical study

Laser technology has affected the field of Periodontology in many ways. They help to manage periodontal disease. This investigation aimed to compare the clinical results of diode laser in conjunction with scaling and root planing (SRP) and SRP alone in treating periodontal pockets in Periodontitis patients. This randomized controlled clinical research utilized a split-mouth approach. It included 25 patients (11 females and 14 males, aged 20 to 65) presenting a moderate periodontal pocket with depths of 4-7 mm on both the right and left sides of the mouth. Two groups were utilized: the control group (SRP alone) on the right side of the mouth and the experimental group (SRP in conjunction with diode laser) on the left side of the mouth. The intervention comprised a single session of scaling and root planing (SRP) accompanied by 10-second administrations of a dual-wavelength diode laser Working within the wavelength range 810-980 nm on the left side. In contrast, the contralateral side received SRP only. Probing Pocket Depth, clinical attachment loss, Plaque Index, and Bleeding on Probing Index were assessed at baseline, 1.5 months, and 3 months post-treatment. The results indicate that both therapies enhanced periodontal parameters at 1.5 and 3 months compared to the baseline. SRP + diode laser, on the other hand, demonstrated a substantial enhancement in probing depth.(PD;4.92 ± 0.65-3.82 ± 0.87-3.55 ± 0.80 vs. 4.95 ± 0.67-4.14 ± 0.93-3.90 ± 0.93, p < 0.001) and BOP%(100.0%-43.2%-34.80% vs. 100.0%-54.8%-44.0%, P < 0.05) in contrast to SRP alone. No substantial differences were detected in CAL and plaque percentages between treatment groups (P > 0.05) at 1.5 and 3 months post-treatment. Conclusions indicate that within the limit of this study, the integration of scaling and root planing (SRP) with diode laser therapy resulted in a significant reduction in moderate periodontal pocket depth and bleeding on probing over the 3-month trial period in patients with Periodontitis.

Mesenchymal stem cell-derived extracellular vesicles in periodontal bone repair

Periodontitis is a chronic inflammatory disease that destroys tooth-supporting structures and poses significant public health challenges due to its high prevalence and links to systemic health conditions. Traditional treatments are effective in reducing the inflammatory response and improving the clinical symptoms of periodontitis. However, these methods are challenging to achieve an ideal treatment effect in alveolar bone repair. Mesenchymal stem cells (MSCs) represent a potential alternative for the treatment of periodontal bone defects due to their self-renewal and differentiation capabilities. Recent research indicates that MSCs exert their effects primarily through paracrine mechanisms. Mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) serve as pivotal mediators in intercellular communication, transferring microRNAs (miRNAs), messenger RNAs (mRNAs), proteins, and cytokines to recipient cells, thereby emulating the therapeutic effects of MSCs. In periodontitis, MSC-EVs play a pivotal role in immunomodulation and bone remodeling, thereby facilitating periodontal bone repair. As a cell-free therapy, MSC-EVs demonstrate considerable clinical potential due to their specialized membrane structure, minimal immunogenicity, low toxicity, high biocompatibility, and nanoscale size. This review indicates that MSC-EVs represent a promising approach for periodontitis treatment, with the potential to overcome the limitations of traditional therapies and offer a more effective solution for bone repair in periodontal disease. In this review, we introduce MSC-EVs, emphasizing their mechanisms and clinical applications in periodontal bone repair. It synthesizes recent advances, existing challenges, and future prospects to present up-to-date information and novel techniques for periodontal regeneration and to guide the improvement of MSC-EV therapy in clinical practice.

Adjunctive therapea - a promising method in the treatment of periodontal disease

OBJECTIVES

The aim of the study is to compare the clinical efficacy of the application of "Armenicum" paste as an adjunct to SRP for the non-surgical treatment of patients with periodontitis.

METHODS

The current RCT prospective study was conducted on 157 patients with chronic periodontitis. The patients were blind randomly assigned into two groups: Group A (SRP + Armenicum" paste) 81 patients (42 males and 39 females, 37 to 68 years) and Group B (SRP) 76 patients (39 males and 37 females, 37 to 68 years). Periodontal indices BOP, PPD, and DPI within each treatment group were measured before periodontal therapy, 3 and 6 months after the treatment. Group A underwent a periodontal treatment which included: supragingival and subgingival scaling, and additional use of local "Armenicum" paste. The Group B group only received supragingival and subgingival scaling.

RESULTS

In our study, the mean BOP, DPI, and PPD showed a statistically significant difference from baseline to 3 months and 6 months (p ≤ 0.05) in both Group A and Group B. But, mean BOP and mean PPD reduction gain was found to be greater in Group-A than Group B at 3 months and 6 months. No statistical differences in clinical indices were recorded depending on gender and age.

CONCLUSION

These results indicate that topical "Armenicum" paste provides an effective adjunctive treatment of chronic periodontitis.

CLINICAL RELEVANCE

The results of the current study showed that the adjunctive use of "Armenicum" reduced signs of inflammation compared to standard SRP treatment alone. Periodontal therapy using Armenicum paste application can be considered as a promising method in the treatment of periodontitis.

Therapeutic potential of boric acid as a local drug delivery agent in periodontitis: a comprehensive systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis aim to evaluate the therapeutic potential of boric acid as a local drug delivery agent in the treatment of periodontitis.

METHODS

Following PRISMA guidelines, we registered a comprehensive protocol with PROSPERO. By employing PICOS criteria, we evaluated randomized controlled trials assessing the effects of subgingival boric acid application alongside non-surgical periodontal therapy in treatment of periodontitis. Studies were systematically searched across multiple databases, with establishment of the eligibility criteria. Data extraction and risk of bias assessment were conducted independently by reviewers.

RESULTS

Among 1,640 records screened, 6 studies met the inclusion criteria, comprising 281 participants aged 18-65 years. At 1-month, boric acid demonstrated significant improvements in probing pocket depth (PPD), but insignificant differences were observed in clinical attachment level (CAL), and gingival index (GI). However, at 3 and 6 months, we found significant reductions in PPD while at 6 months, a significant increase in CAL gain were observed favoring boric acid. No significant changes in GI were noted at any follow-up duration.

CONCLUSION

Boric acid adjunctive therapy in non-surgical periodontal treatment shows promising efficacy in improving clinical parameters, particularly PPD and CAL, over time. While early outcomes may not show significance, sustained benefits are evident at longer follow-up periods. These findings underscore the potential of boric acid as a valuable addition to periodontal therapy, demanding further investigation to reveal its precise mechanisms and optimize clinical application.

Therapeutic effect of mesenchymal stem cell-derived exosome therapy for periodontal regeneration: a systematic review and meta-analysis of preclinical trials

BACKGROUND

To assess the therapeutic effects of mesenchymal stem cell (MSC)-derived exosome therapy on periodontal regeneration and identify treatment factors associated with enhanced periodontal regeneration in recent preclinical studies.

METHODS

Searches were conducted in PubMed, Cochrane Library, EMBASE, and Web of Science databases until October 10, 2024. A risk of bias (ROB) assessment was performed using the SYRCLE tool. Osteogenic-related parameters were used as the primary outcome measures.

RESULTS

In total, 1360 articles were identified, of which 17 preclinical studies were based on MSC-derived exosome therapy, and they demonstrated a beneficial effect on BV/TV (SMD = 13.99; 95% Cl = 10.50, 17.48; p < 0.00001), CEJ-ABC (SMD = -0.22; 95% Cl = -0.31, -0.13; p < 0.00001), BMD (SMD = 0.29; 95% Cl = 0.14, 0.45; p = 0.0002), and Tp.Sp (SMD = -0.08; 95% Cl= -0.15, -0.02; p = 0.02) compared with the control group. However, no significant differences were observed in Tp.Th (SMD = 0.03; 95% CI = 0.00, 0.07; p = 0.09) between the exosome-treated group and control group. Additionally, subgroup analysis indicated that preconditioned exosomes (p = 0.03) significantly improved BV/TV. In contrast, there were no significant differences in the enhancement of BV/TV with respect to the application method (p = 0.29), application frequency (p = 0.10), treatment duration (p = 0.15), or source of MSCs (p = 0.31).

CONCLUSIONS

MSC-derived exosomes show great promise for enhancing the quality of periodontal regeneration. However, more standardized and robust trials are needed to reduce heterogeneity and bias across studies and to confirm the therapeutic parameters associated with the enhancement of periodontal regeneration by MSC-derived exosomes.

REGISTRATION

CRD42024546236.

Myeloid dendritic cells and periodontal disease association: integrated study of single-cell sequencing and Mendelian randomization analysis

Background

Periodontal disease is a widespread inflammatory condition that compromises the supporting structures of the teeth, potentially resulting in tooth loss if left untreated. Despite advancements in therapeutic interventions and an enhanced understanding of its pathophysiology, emerging techniques such as single-cell RNA sequencing (scRNA-seq) and Mendelian randomization (MR) present new opportunities for precision medicine in the management of periodontal disease.

Methods

Data derived from the GSE152042 dataset underwent rigorous quality control, normalization, and dimensionality reduction using Seurat and the MonacoImmuneData framework. Marker genes were identified to delineate subgroups for subsequent analysis utilizing CellChat and ClusterProfilerR. MR analysis of the expression quantitative trait loci (eQTLs) for these genes was conducted to determine causal relationships with periodontal disease, leveraging data from the IEU Open GWAS project.

Results

Single-cell analysis revealed distinct immune cell subtypes and indicated an increased presence of myeloid dendritic cells (mDCs) in patients with periodontal disease. MR analysis identified twenty-six significant genes, with LIMA1 (LIM domain and actin-binding 1) demonstrating a robust causal association with the progression of periodontal disease. Gene ontology and Kyoto Encyclopedia of Genes and Genomes analyses highlighted crucial pathways involved in periodontal inflammation and tissue destruction. Visualization at the single-cell level elucidated the role of LIMA1 in disease progression, alongside differences in cell communication dynamics between LIMA1-positive and -negative populations.

Conclusion

This study underscores the utility of scRNA-seq and MR in elucidating essential factors in the pathogenesis of periodontal disease, thereby reinforcing the necessity for targeted therapeutic strategies. The identification of LIMA1 as a pivotal gene in periodontal disease progression opens new avenues for precision medicine approaches, potentially enhancing treatment efficacy and patient outcomes in periodontal management.

Humic Acid Derived from Agricultural Biomass Mitigates Alveolar Bone Loss and Modulates Systemic Inflammatory Cytokines in Rats with Periodontitis

BACKGROUND

Humic acid (HA) is a bioproduct that can be extracted from different sources and has anti-inflammatory properties that have been little explored in the treatment and prevention of Periodontal Disease (PD). Thus, we aimed to investigate the effects of oral administration of HA on the progression of PD in rats.

METHODS

Twenty-four male Wistar rats were distributed into three experimental groups (Control/ Sham, PD, and PD + HA). HA was administered by gavage (80 mg/kg/day) for 28 days, and PD was induced 14 days after the beginning of treatment. Bone loss, bone topography, and surface elemental composition were analyzed. Circulating IL1-beta, TNF-alpha, and IL-10 levels were evaluated through Enzyme-Linked Immunosorbent Assay (ELISA).

RESULTS

The animals treated with HA showed lower bone loss (p < 0.05). Calcium and phosphorus levels on the alveolar bone surface were lower in the PD group (p < 0.05) compared to the control group, whereas the animals treated with HA exhibited attenuation in this loss (p < 0.05). The animals treated with HA showed reduced TNF-alpha, IL1-beta, IL-10, and the TNF-alpha/IL-10 ratio compared to those with PD (p < 0.05).

CONCLUSION

Treatment with HA attenuated the parameters of alveolar bone loss and modulated systemic inflammatory parameters in rats with ligature-induced PD.

Assessing the Impact of Stem Cell-based Therapy on Periodontal Health: A Meta-analysis of Clinical Studies

OBJECTIVE

While clinical trials exploring stem cells for regenerating periodontal tissues have demonstrated positive results, there is a limited availability of systematic literature reviews on this subject. To gain a more comprehensive understanding of stem cell interventions in periodontal regeneration, this meta-analysis is undertaken to assess the beneficial effects of stem cells in human periodontal regeneration.

METHODS

"PubMed," "PubMed Central," "Web of Science," "Embase Scopus" "Wanfang," and "CNKI," were used to extract clinical studies related to the utilization of stem cells in repairing periodontal tissue defects. This search included studies published up until October 5, 2023. The inclusion criteria required the studies to compare the efficacy of stem cell-based therapy with stem cell-free therapy for regenerating periodontal tissues. Meta-analysis was conducted using Review Manager software (version 5.4).

RESULTS

This meta-analysis synthesized findings from 15 selected studies investigating the impact of stem cell interventions on periodontal tissue regeneration. The "stem cell" group displayed a substantial reduction in clinical attachment level (CAL) compared to the "control" group within 3 to 12 months post-surgery. However, no significant differences in CAL gain were found between groups. Probing pocket depth (PPD) significantly decreased in the "stem cell" group compared to the "control" group, particularly for follow-up periods exceeding 6 months, and dental stem cell treatment exhibited notable improvements. Conversely, no significant differences were observed in PPD reduction. Gingival recession (GR) significantly decreased in the "stem cell" group compared to the "control" group at 3 to 12 months post-surgery. No significant differences were observed in GR reduction between groups. No significant differences were identified in cementoenamel junction-bone distance reduction, infrabony defect reduction, or bone mineral density increase between the two groups. Furthermore, no significant changes were observed in the gingival index, plaque index, or width of keratinized gingiva.

CONCLUSION

In conclusion, while stem cell-based therapy offers promising prospects for periodontal defect treatment, there are notable limitations in the current body of research. Larger, multicenter, double-blind RCTs with robust methodologies are needed to provide more reliable evidence for stem cell-based intervention in periodontitis.

Time-Responsive Activity of Engineered Bacteria for Local Sterilization and Biofilm Removal in Periodontitis

Periodontitis is a highly prevalent and common condition in people of all ages, however, existing drugs to treat periodontitis have difficulty penetrating complex biofilms. Here, we report a biofilm-penetrating probiotic hybrid strategy for the treatment of periodontitis. It consists of therapeutic probiotics of E. coli Nissle 1917, which can produce antimicrobial peptides and hydrogen, and is coated with D-amino acids that can penetrate biofilms. After the fusion of D-amino acids with the biofilm, EcN entered the plaque biofilm and produced antimicrobial peptides to kill porphyromonas gingivalis and eliminate periodontitis under the action of hydrogen. The efficacy of EcN@DA-D in biofilm penetration and treatment of periodontitis was demonstrated in a rat model of periodontitis. In addition, the clinical combination to construct a rat periodontitis model by using clinical tissue has a significant therapeutic effect. In conclusion, EcN@DA-D offers a promising topical treatment for periodontitis without developing detectable pathogen resistance and side effects.

A hierarchical Bilayered scaffold for periodontal complex structure regeneration

The periodontal tissue comprises alveolar bone, cementum, and periodontal ligament (PDL), forming a highly hierarchical architecture. Although current therapies could regenerate the hard tissue well, the simultaneous reconstruction of hard and soft tissue remains a great clinical challenge with the major difficulty in highly orientated PDL regeneration. Using the unidirectional freeze-casting method and biomimetic mineralization technique, we construct a hierarchical bilayer scaffold with the aligned chitosan scaffold with ZIF-8 resembling PDL, and intrafibrillarly mineralized collagen resembling alveolar bone. The hierarchical bilayer scaffold exhibits different geomorphic clues and chemical microenvironments to realize a perfect simulation of the natural periodontal hierarchical architecture. The aligned scaffold with ZIF-8 could induce the fibrogenic differentiation of bone mesenchymal stromal cells (BMSCs), and the mineralized scaffold could induce osteogenic differentiation of BMSCs. The hierarchical bilayer scaffold could simulate periodontal complex tissue, exhibiting great promise for synchronized multi-tissue regeneration of periodontal tissue.

Self-Reported Oral Hygiene Performance of Patients in Albania: A Questionnaire-Based Survey

Background/Objectives: Oral hygiene is a key factor for dental and periodontal diseases and the prognosis of any treatment to restore their consequences. The present survey aimed to evaluate how well informed patients in Albania are on oral hygiene, given the scarce evidence on this topic. Methods: This survey was performed using a Google Forms questionnaire on oral hygiene habits, type and technique of instruments used, and frequency of dental recall visits. Results: A total of 1006 questionnaires were filled in a one-month time period (January 2020) from a population of 75.2% females and 24.8% males, 32.7 ± 11.3 years of age, from whom 94.6% reported a lack of systemic diseases and 80% were non-smokers. All of the population brushed their teeth at least once daily. The most used type of toothbrush was a manual one (91.1%) with medium-bristle hardness in 71% of cases. The most prevalent way of using the toothbrush was through circular movements (36.7%) with a duration of 2-3 min in 72% of the population. Only 77.1% of the population used interdental instruments, mainly interdental floss. Conclusions: Within the limits of this study, it could be concluded that the present population seemed to be mostly appropriately informed, but the information needs further revision and promotion by dentists.

The prohibitin ligand IN44 decreases Porphyromonas gingivalis mediated inflammation

BACKGROUND

Periodontitis is an inflammatory disease causing destruction of periodontal tissues. Controlling inflammation is crucial for periodontitis treatment. Prohibitins (PHBs) are emerging targets in the treatment of inflammatory diseases. To identify compounds that would alleviate periodontitis, several small molecules that directly target PHBs and display various pharmacological activities were screened to decrease Porphyromonas gingivalis induced inflammation. Indeed, IN44, a new PHB ligand that has been shown to inhibit STAT3 and NF-kB signaling, suggesting that it may alleviate periodontitis. This study aimed to assess IN44's impact on inflammation elicited by P. gingivalis.

METHODS

In vitro, IN44 cytotoxicity was tested on periodontal cells with AlamarBlue and Live/Dead assays. Its effect on cytokines and mitochondrial ROS production were evaluated using ELISA and Mitosox assay. In mouse, systemic inflammation and experimental periodontitis were induced to assess IN44's therapeutic effects.

RESULTS

In vitro, IN44 (50 µM) showed no cytotoxicity on periodontal cells. It significantly reduced pro-inflammatory cytokine secretion and mitochondrial ROS in P. gingivalis-infected epithelial cells. Proteome analysis on infected epithelial cells revealed modulation of HSP60 and Akt expression by IN44. In vivo, IN44 demonstrated anti-inflammatory effects in a mouse model of systemic inflammation induced by P. gingivalis, and it improved periodontal healing.

CONCLUSION

These findings suggest that PHBs may warrant consideration as therapeutic targets for periodontitis and possibly other inflammatory disorders.

Development of subgingival calculus detector utilizing optical fiber: Verification of its potential for clinical application

The removal of subgingival deposits, especially calculus, plays a crucial role in basic periodontal therapy. However, manual detection methods affect accuracy owing to the operator's skill. To avoid this uncertainty, we have developed a calculus detection device named "Sensor probe" and evaluated its ability to detect calculus for future clinical applications. The Sensor probe consisted of a 635 nm-wavelength semiconductor laser and a 0.5 mm-diameter single-mode optical fiber. Initially, the performance of the device was evaluated using clinically obtained extracted teeth with calculus covered with a stainless-steel shielding plate with pinhole. Then, the effect of the optical fiber's end shape on calculus detection performance was analyzed. Lastly, the performance of the Sensor probe was compared to that of a conventional periodontal probe in terms of accuracy, sensitivity, and specificity for calculus detection using calculus-covered extracted teeth. The results indicated that Sensor probe detected dental calculus through the pinhole with a diameter of 300 μm or more when applied from a distance of 100 μm. The results analyzing the effect of the optical fiber's end shape on calculus detection performance showed that cutting the fiber end at an angle of 45° resulted in the most effective calculus detection. This may be because the laser light refracted on the cut surface and concentrated on the fiber side. Moreover, by comparing the performance of this device to a conventional periodontal probe revealed that the Sensor probe showed improved calculus detection accuracy in deeper periodontal pockets. This improvement was particularly significant in the apical third, where detection is typically difficult. In conclusion, a Sensor probe that uses an optical fiber with a 45° angled end may facilitate subgingival calculus detection. In future clinical applications, Sensor probes could lead to more accurate and efficient calculus removal, especially for deeper periodontal pockets.

Insight into the role of macrophages in periodontitis restoration and development

Periodontitis is one of the chronic diseases that have the greatest impact on human health, and it is associated with several other chronic diseases. Tissue damage associated with periodontitis is often connected with immune response. Immune cells are a crucial component of the human immune system and are directly involved in periodontitis during the inflammatory phase of the disease. Macrophages, as a key component of the immune system, are responsible for defence, antigen presentation and phagocytosis in healthy tissue. They are also closely linked to the development and resolution of periodontitis, through mechanisms such as macrophage polarization, pattern recognition receptors recognition, efferocytosis, and Specialized Pro-resolving Mediators (SPMs) production. Additionally, apoptosis and autophagy are also known to play a role in the recovery of periodontitis. This review aims to investigate the aforementioned mechanisms in more detail and identify novel therapeutic approaches for periodontitis.

Current status of Er:YAG laser in periodontal surgery

Lasers have numerous advantageous tissue interactions such as ablation or vaporization, hemostasis, bacterial killing, as well as biological effects, which induce various beneficial therapeutic effects and biological responses in the tissues. Thus, lasers are considered an effective and suitable device for treating a variety of inflammatory and infectious conditions of periodontal disease. Among various laser systems, the Er:YAG laser, which can be effectively and safely used in both soft and hard tissues with minimal thermal side effects, has been attracting much attention in periodontal therapy. This laser can effectively and precisely debride the diseased root surface including calculus removal, ablate diseased connective tissues within the bone defects, and stimulate the irradiated surrounding periodontal tissues during surgery, resulting in favorable wound healing as well as regeneration of periodontal tissues. The safe and effective performance of Er:YAG laser-assisted periodontal surgery has been reported with comparable and occasionally superior clinical outcomes compared to conventional surgery. This article explains the characteristics of the Er:YAG laser and introduces its applications in periodontal surgery including conventional flap surgery, regenerative surgery, and flapless surgery, based on scientific evidence from currently available basic and clinical studies as well as cases reports.

Humic Acid Derived from Vermicompost Inhibits Alveolar Bone Degradation and Protects Against Renal Injury in an Experimental Model of Periodontitis

Background: Periodontal disease (PD) leads to the destruction of supportive tissues through an inflammatory response induced by biofilm accumulation. This low-grade systemic inflammation from PD increases the risk of comorbidities. Among potential therapeutic agents for PD, humic acids (HAs) are notable for their anti-inflammatory and immunomodulatory properties. This study aimed to evaluate the effects of varying HA doses on PD progression in an experimental model. Methods: Fifty-four Wistar rats were assigned to six groups (n = 8 each): control, PD, PD + 40 mg/kg HA, PD + 80 mg/kg HA, PD + 160 mg/kg HA, and PD + 320 mg/kg HA. HA from vermicompost was administered daily by gavage for 28 days, with PD induced by ligature on day 14. Post-euthanasia, mandibular samples were analyzed histomorphometrically for bone loss and osteocyte density. Alveolar bone topography and elemental composition were examined using Scanning Electron Microscopy (SEM) coupled with Energy Dispersive Spectroscopy (EDS). Renal and hepatic tissues were assessed histopathologically. Data were analyzed with Analysis of Variance (ANOVA) and Duncan's test. Results: HA-treated animals showed reduced epithelial attachment loss and alveolar bone loss, with improved bone quality parameters, such as reduced pore number and diameter and increased osteocyte density compared to the PD group. Renal lesions observed in PD animals were mitigated at 40 and 80 mg/kg HA doses. Conclusions: HA treatment improves alveolar bone integrity and, at lower doses, reduces PD-induced renal lesions.

Beneficial effects of non-invasive physical plasma on human periodontal ligament cells in vitro

Introduction

Periodontitis is a chronic inflammatory disease of the periodontium that can lead to the loss of affected teeth if left untreated. It is induced by a multifactorial process centered on microbial pathogens such as Fusobacterium nucleatum (F.n.). Non-invasive physical plasma (NIPP), a highly reactive gas, has become a focus of research, not only for its hemostatic, proliferation-enhancing and apoptotic properties, but also for its antimicrobial potential. The objective of this study was to examine the impact of NIPP on human periodontal ligament (PDL) cells that had been induced into a state of periodontal infection in vitro.

Methods

Initially, the solitary effect of NIPP was evaluated by measuring temperature and pH and analyzing reactive oxygen species (ROS). Additionally, DAPI and phalloidin staining were employed to investigate possible cytotoxic effects. The cells were pre-incubated with F.n. and treated with NIPP after 24 hours. Interleukin (IL)-6 and IL-8 were analyzed at mRNA and protein levels, respectively, by real-time PCR and ELISA.

Results

NIPP alone had no significant effect on PDL cells. However, the F.n.-induced upregulation of IL-6 and IL-8 was counteracted by NIPP.

Discussion

Thus, the utilization of NIPP may be regarded as a promising therapeutic strategy for the treatment of periodontal diseases.

Efficacy of adjunctive systemic or local antibiotic therapy in peri-implantitis: a systematic review and meta-analysis of randomized controlled clinical trials

This systematic review and meta-analysis considered the results of randomized controlled clinical trials (RCTs) to evaluate the efficacy of systemic or local antibiotic therapy in peri-implantitis. Two independent authors screened publications from three electronic databases to include RCTs meeting all the inclusion and exclusion criteria. A meta-analysis was performed to evaluate the weighted mean differences in survival rate (SR) and changes in pocket probing depth (PPD), bone level (BL), and clinical attachment level (CAL). The study cohorts were defined as antibiotic and control groups with subgroups for analysis. Seven studies including 309 patients (390 implants) were considered. Within the limitations of this review, patients in the antibiotic groups exhibited significant improvements in PPD. Subgroup analysis indicated that the administration of systemic antibiotics or the use of antibiotics in non-surgical treatments did not result in a significant alteration in BL. It was established that the addition of antibiotics can ameliorate PPD and SR in the treatment of peri-implantitis, whether through surgical or non-surgical approaches, and also shows moderate performance regarding BL and CAL. Considering the lack of application of new technologies in the control group and the hardship of assessing the potential risks of antibiotics, careful clinical judgment is still necessary.

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.

Treatment Approach to Generalized Severe Periodontitis With the Potential for Additional Tooth Loss: A Case Report

Generalized severe periodontitis, with the potential for additional tooth loss, is one of the most common forms of periodontitis today. Early diagnosis and treatment approaches are of utmost importance. Therapeutic measures must be well thought out and follow a strict sequence. This case report presents the treatment of a patient with stage 3 periodontitis and includes information on both the non-surgical part of the therapy and the surgical intervention in a single area with an existing vertical bone defect. An innovative method of regenerative therapy (guided tissue regeneration with barrier collagen membrane and autogenous platelet-rich plasma) was selected for the treatment of the vertical bone defect in the medial zone of tooth #46.

Recent Advances in Basic Studies of Low-Intensity Pulsed Ultrasound in Periodontal Tissue Regeneration: A Systematic Review

Approximately half of the adult population is suffering from periodontal disease, and conventional periodontal treatment strategies can only slow the progression of the disease. As a kind of tissue engineering, periodontal regeneration brings hope for the treatment of periodontal disease. Low-intensity pulsed ultrasound (LIPUS) is a form of ultrasound with a frequency of 1-3 MHz and a much lower intensity (< 1W/cm2) than traditional ultrasound energy and output. LIPUS has been adopted for a variety of therapeutic purposes due to its bioeffects such as thermal, mechanical, and cavitation effects, which induce intracellular biochemical effects and lead to tissue repair and regeneration ultimately. In this systematic review, we summarize the basic research of LIPUS in the treatment of periodontal disease in periodontal disease animal models and the influence of LIPUS on the biological behavior (including promoting osteogenic differentiation of stem cells and inhibiting inflammatory response) and potential mechanism of periodontal ligament stem cells (PDLSCs), hoping to provide new ideas for the treatment of periodontal disease. We believe that LIPUS can be used as an auxiliary strategy in the treatment of periodontal disease and play an exciting and positive role in periodontal regeneration.

Bioinspired Glycopeptide Hydrogel Reestablishing Bone Homeostasis through Mediating Osteoclasts and Osteogenesis in Periodontitis Treatment

Irreversible alveolar bone resorption is one of the important clinical manifestations of periodontitis, which is initiated by a plaque biofilm and exacerbated by the imbalance of osteoclast activity and osteogenesis, affecting a patient's masticatory function and resulting in a high recurrence rate of periodontitis. Herein, to reestablish bone homeostasis in periodontitis, a minocycline hydrochloride (MH)-loaded glycopeptide hydrogel (MH/GRWgel) is fabricated to mediate alveolar bone absorption through sequential antibacterial and RANKL-blocking activities. GRWgel shows an ECM-like fibrous and porous microstructure serving as a scaffold for cell proliferation and differentiation and holds the merits including injectability, self-healing properties, and good biocompatibility. After injection in situ, MH is released rapidly from the hydrogel in the early stage, demonstrating a potent antimicrobial effect to combat the biofilm in the deep periodontal pocket. Moreover, MH/GRWgel exhibits a high specific binding efficiency with RANKL to suppress osteoclast maturation by shielding the RANKL/RANK interaction and enhancing osteogenic differentiation, thereby synergistically regulating bone homeostasis. In the rat periodontitis model, MH/GRWgel significantly curtails periodontitis progression through antimicrobial activity, inhibition of alveolar bone resorption, and promotion of bone regeneration, which is superior to the treatment of a commercial gel. These findings suggest that MH/GRWgel with superiority in regulating bone homeostasis provides a promising therapeutic strategy for periodontitis.

Navigating the Landscape of Periodontitis Nonsurgical Treatment: A Metatrend Study of The Scientific Production and Trends From 2001-2020

Nonsurgical therapies have been recommended and employed as a less invasive and cost-effective modality in managing periodontitis. In this context, different therapeutic protocols have been tested in the last decades. Therefore, mapping the scientific trends and patterns provides critical insights into the state of research in the field, which has not been explored for overall nonsurgical periodontitis treatment studies. Articles from 2001 to 2020 were retrieved from the Web of Science database using appropriate terms and keywords. Article selection and data extraction were performed by calibrated examiners. All articles focusing on nonsurgical periodontitis treatment were included. Descriptive, bivariate, and multivariate logistic regression analyses were conducted. 1,519 articles were included. Randomized clinical trials (RCTs) were the most used design (44.1%), and professional biofilm control was the topic most studied (35.6%). Europe published the most significant number of articles (41.1%). The USA was the country that collaborated more with other countries. Asia (p<0.001), South America (p=0.004), and Oceania/Africa (p=0.016) showed a lower chance to have international collaboration. Studies from North America were more likely to be RCTs than studies from Europe (p=0.050); studies focusing on professional biofilm control (p<0.001) and other topics (p<0.001) were less likely to be evaluated by RCTs. The nonsurgical periodontitis treatment field mainly conducted RCTs, and the topic most explored by all studies was professional biofilm control. International collaboration and conduct of RCTs in this field occurred mainly among high-income countries. Decentralizing scientific resources, making integrative connections globally, and evaluating new topics may improve evidence-based periodontology.

Advances and challenges in the development of periodontitis vaccines: A comprehensive review

Periodontitis is a prevalent polymicrobial disease. It damages soft tissues and alveolar bone, and causes a significant public-health burden. Development of an advanced therapeutic approach and exploration of vaccines against periodontitis hold promise as potential treatment avenues. Clinical trials for a periodontitis vaccine are lacking. Therefore, it is crucial to address the urgent need for developing strategies to implement vaccines at the primary level of prevention in public health. A deep understanding of the principles and mechanisms of action of vaccines plays a crucial role in the successful development of vaccines and their clinical translation. This review aims to provide a comprehensive summary of potential directions for the development of highly efficacious periodontitis vaccines. In addition, we address the limitations of these endeavors and explore future possibilities for the development of an efficacious vaccine against periodontitis.

Multifunctional human serum albumin-crosslinked and self-assembling nanoparticles for therapy of periodontitis by anti-oxidation, anti-inflammation and osteogenesis

Periodontitis is a chronic inflammatory disease that can result in the irreversible loss of tooth-supporting tissues and elevate the likelihood and intensity of systemic diseases. The presence of reactive oxygen species (ROS) and associated related oxidative stress is intricately linked to the progression and severity of periodontal inflammation. Targeted removal of local ROS may serve to attenuate inflammation, improve the unfavorable periodontal microenvironment and potentially reverse ensuing pathological cascades. These ROS scavenging nanoparticles, which possess additional characteristics such as anti-inflammation and osteogenic differentiation, are highly sought after for the treatment of periodontitis. In this study, negative charged human serum albumin-crosslinked manganese-doped self-assembling Prussian blue nanoparticles (HSA-MDSPB NPs) were fabricated. These nanoparticles demonstrate the ability to scavenge multiple ROS including superoxide anion, free hydroxyl radicals, singlet oxygen and hydrogen peroxide. Additionally, HSA-MDSPB NPs exhibit the capacity to alleviate inflammation in gingiva and alveolar bone both in vitro and in vivo. Furthermore, HSA-MDSPB NPs have been shown to play a role in promoting the polarization of macrophages from the M1 to M2 phenotype, resulting in reduced production of pro-inflammatory cytokines. More attractively, HSA-MDSPB NPs have been demonstrated to enhance cellular osteogenic differentiation. These properties of HSA-MDSPB NPs contribute to decreased inflammation, extracellular matrix degradation and bone loss in periodontal tissue. In conclusion, the multifunctional nature of HSA-MDSPB NPs provides a promising therapeutic approach for the treatment of periodontitis.