Impact of local drug delivery and natural agents as new target strategies against periodontitis: new challenges for personalized therapeutic approach

Low salivary uric acid levels are independently associated with periodontitis

BACKGROUND

Lower salivary uric acid concentrations, the most abundant antioxidant agent in saliva, have been observed in patients with periodontitis compared to individuals with periodontal health. However, the independent association of salivary uric acid levels with periodontitis, accounting for other risk factors, as well as its association with periodontitis severity, has not been investigated.

AIM

To the independent association of salivary uric acid levels with periodontitis and the association of salivary uric acid levels with the severity of periodontitis.

METHODS

This observational and prospective study measured salivary uric acid levels in subjects with periodontitis (characterized by periodontal loss of tissue) and in subjects without periodontitis (periodontal health or localized gingivitis in < 30% of sites). Multivariate regression analysis was performed to determine independent factors associated with periodontitis. Spearman’s rho correlation coefficient was used to assess the relationship between salivary uric acid levels and periodontitis severity. A receiver operating characteristic analysis was carried out to evaluate the diagnostic performance of salivary uric acid levels in periodontitis, reporting the area under curve (AUC) and its 95%CI.

RESULTS

We included 121 subjects, 61 of them with periodontitis and 60 without periodontitis (39 with periodontal health and 21 with local gingivitis). Subjects with periodontitis compared to those without periodontitis were older (P < 0.001), had higher salivary uric acid levels (P = 0.002), higher rate of arterial hypertension history (P = 0.001) and higher rate of never-smoker history (P < 0.001). The AUC for periodontitis diagnosis by salivary uric acid levels was 66% (95%CI: 57%-75%; P < 0.001) and the better cut-off point was 111 nmol/mL. Multiple logistic regression analysis showed an independent association of salivary uric acid levels < 111 nmol/mL (OR = 6.14; 95%CI: 2.015-18.721; P = 0.001) with periodontitis after controlling for age, never-smoker history and arterial hypertension. A negative correlation of salivary uric acid levels and periodontitis severity was observed (rho = -0.32; P < 0.001).

CONCLUSION

The two novel findings of our research were, first, that low salivary uric acid concentrations are independently associated with periodontitis, even after accounting for established risk factors. Second, salivary uric acid levels show a negative correlation with periodontitis severity.

A state-of-the-art review of the recent advances in drug delivery systems for different therapeutic agents in periodontitis

Periodontitis (PD) is a chronic gum illness that may be hard to cure for a number of reasons, including the fact that no one knows what causes it, the side effects of anti-microbial treatment, and how various kinds of bacteria interact with one another. As a result, novel therapeutic approaches for PD treatment must be developed. Additionally, supplementary antibacterial regimens, including local and systemic medication administration of chemical agents, are necessary for deep pockets to assist with mechanical debridement of tooth surfaces. As our knowledge of periodontal disease and drug delivery systems (DDSs) grows, new targeted delivery systems like extracellular vesicles, lipid-based nanoparticles (NPs), metallic NPs, and polymer NPs have been developed. These systems aim to improve the targeting and precision of PD treatments while reducing the systemic side effects of antibiotics. Nanozymes, photodermal therapy, antibacterial metallic NPs, and traditional PD therapies have all been reviewed in this research. Medicinal herbs, antibiotics, photothermal therapy, nanozymes, antibacterial metallic NPs, and conventional therapies for PD have all been examined in this research. After that, we reviewed the key features of many innovative DDSs and how they worked for PD therapy. Finally, we have discussed the advantages and disadvantages of these DDSs.

Design and application of antimicrobial nanomaterials in the treatment of periodontitis

Periodontitis is a chronic inflammatory disease induced by the microbiome, leading to the destruction of periodontal structures and potentially resulting in tooth loss. Using local drug delivery systems as an adjunctive therapy to scaling and root planning in periodontitis is a promising strategy. However, this administration method's effectiveness is constrained by the complexity of the periodontal environment. Nanomaterials have demonstrated significant potential in the antibacterial treatment of periodontitis, attributed to their controllable size, shape, and surface charge, high design flexibility, high reactivity, and high specific surface area. In this review, we summarize the complex periodontal microenvironment and the difficulties of local drug delivery in periodontitis, explicitly reviewing the application and design strategies of nanomaterials with unique properties in the distinct microenvironment of periodontitis. Furthermore, the review discusses the limitations of current research, proposes feasible solutions, and explores prospects for using nanomaterials in this context.

The Effectiveness of Metronidazole as a Localized Drug Delivery System in the Treatment of Periodontal Diseases: A Narrative Review

Periodontitis is a complex, multifactorial chronic inflammatory condition that impacts the adjacent hard and soft tissues. Microorganisms, especially gram-negative anaerobic pathogens, are a causative factor for periodontal disease. Periodontitis is identified by observing deeper periodontal pockets, clinical attachment loss, and the reduction of alveolar bone, often in conjunction with these indicators. The condition can vary in severity and be classified as mild, moderate, or severe. Scaling and root planing, combined with mechanical debridement, may not adequately reduce the bacterial load; therefore, adding local or systemic antimicrobials is advised as an adjunctive treatment. Commonly utilized local drug delivery agents for patients suffering from periodontitis include tetracycline, metronidazole, minocycline, doxycycline, and chlorhexidine. This system targets the pockets and eliminates the pathogens. Metronidazole is a nitroimidazole compound used commonly against gram-negative anaerobes. Its mechanism lies in four basic steps through which bacterial cell death occurs. A 25% metronidazole gel is used widely in periodontitis patients. The effectiveness of metronidazole as a local drug delivery agent has been evaluated in numerous studies, which have shown improvements in clinical parameters. To achieve favorable clinical outcomes, the non-surgical treatment of peri-implantitis should involve the systemic or local administration of metronidazole. Thus, the role of metronidazole in the emergence of periodontal diseases and its therapeutic uses are investigated in this narrative review.

The Role of Hyaluronic Acid in Alveolar Ridge Preservation: A Systematic Review of Its Biological and Regenerative Potential According to PRISMA Guidelines and the Cochrane Handbook

Objectives: This systematic review evaluates the biological activity and regenerative potential of hyaluronic acid (HA) in alveolar ridge preservation (ARP) following tooth extraction, assessing its efficacy in reducing bone resorption and promoting bone regeneration when combined with xenografts. Methods: A comprehensive search was conducted across PubMed, Scopus, Web of Science, and Lilacs databases, adhering to PRISMA guidelines. Studies from 2012 to December 2024 involving human participants were included based on a PECO framework. Four studies met the inclusion criteria, with data extracted and analyzed for clinical and histological outcomes. The risk of bias was assessed using the ROBINS-E tool. Results: The included studies demonstrated that HA combined with xenografts significantly reduced post-extraction bone resorption compared to controls. HA-enhanced grafts showed superior radiographic and histological outcomes, including increased bone density and reduced graft shrinkage. While one randomized controlled trial found no significant differences in wound healing or patient-reported outcomes between HA and control groups, other studies reported improved bone formation and graft stability with HA. Variability in study design and sample size was noted, with a generally moderate to high risk of bias in some studies. Conclusions: The evidence supports the beneficial role of HA as an adjuvant in ARP procedures, enhancing bone regeneration and limiting resorption. However, further research with larger samples and standardized methodologies is required to confirm these findings and optimize clinical protocols.

Eupalinolide B inhibits periodontitis development by targeting ubiquitin conjugating enzyme UBE2D3

Periodontitis is a chronic periodontal inflammatory disease caused by periodontal pathogens commonly seen in adults. Eupalinolide B (EB) is a sesquiterpenoid natural product extracted from Eupatorium lindleyanum and has been reported as a potential drug for cancers and immune disorders. Here, we explored the ameliorative effects and underlying molecular mechanism of EB on periodontitis for the first time. We demonstrated that EB ameliorates periodontal inflammation and alveolar bone resorption with a ligated periodontitis mouse model. In addition, the impact of EB on macrophages inflammation was examined in the Raw264.7 cell line. We identified ubiquitin-conjugating enzyme, UBE2D3, as the direct covalent binding protein targets of EB by using a chemoproteomic method based on activity-based protein profiling, biolayer interferometry method, and cellular thermal shift assay. Furthermore, the direct binding site of EB to UBE2D3 was identified using high-resolution mass spectrometry and confirmed by experiments. Taken together, EB ameliorates periodontitis by targeting UBE2D3 to suppress the ubiquitination degradation of IκBα, leading to inactivation of nuclear transcription factor-κB signaling pathway. And this was confirmed by siRNA-mediated gene knockdown in inflammatory macrophages. Our results suggested that EB may be a new kind of UBE2D3 inhibitor and may become a promising therapeutic agent for anti-periodontitis.

Comparative drug release kinetics of Terminalia arjuna mediated SeNPs NanoGel and ZnONPs NanoGel - An in-vitro study

Background

This study compared the drug release kinetics of Terminalia arjuna mediated selenium nanoparticles (SeNPs) gel and zinc oxide nanoparticles (ZnONPs) gel for their potential in local drug delivery for chronic periodontitis.

Material and method

The drug release was evaluated in-vitro by conducting tests on different formulations, including 1 %, 2 %, 3 %, 4 %, and 5 % Terminalia arjuna mediated SeNPs gel and ZnONPs gel. Each sample, approximately 0.1 mg, was mixed with 10 mL of phosphate buffer saline (PBS) at various pH levels and maintained at 37 °C. The suspension was then placed in an incubated shaker at 120 rpm for 1 h. Five-milliliter samples were withdrawn from the dissolution medium at 30-min intervals and replaced with fresh PBS buffer to maintain a constant volume. The released drug amount was measured using a UV spectrophotometer (Systronics, India) at 290 nm.

Result

The investigation revealed that SeNPs gel exhibited higher drug release percentages compared to ZnONPs gel across various concentrations and time points. The sustained release profiles of both formulations suggest effective control over drug release, maintaining therapeutic drug levels over an extended period. The near-complete release of the drug at 500 min highlights the potential for prolonged therapeutic efficacy, reducing the need for frequent dosing and enhancing patient compliance.

Conclusion

Terminalia arjuna mediated SeNPs gel shows promise for more rapid and sustained drug delivery in the management of chronic periodontitis through local drug delivery systems.

Prospective and challenges of locally applied repurposed pharmaceuticals for periodontal tissue regeneration

Periodontitis is a persistent inflammatory condition that causes periodontal ligament degradation, periodontal pocket development, and alveolar bone destruction, all of which lead to the breakdown of the teeth's supporting system. Periodontitis is triggered by the accumulation of various microflora (especially anaerobes) in the pockets, which release toxic substances and digestive enzymes and stimulate the immune system. Periodontitis can be efficiently treated using a variety of techniques, both regional and systemic. Effective therapy is dependent on lowering microbial biofilm, minimizing or eradicating pockets. Nowadays, using local drug delivery systems (LDDSs) as an adjuvant therapy to phase I periodontal therapy is an attractive option since it controls drug release, resulting in improved efficacy and lesser adverse reactions. Choosing the right bioactive agent and mode of delivery is the foundation of an efficient periodontal disease management approach. The objective of this paper is to shed light on the issue of successful periodontal regeneration, the drawbacks of currently implemented interventions, and describe the potential of locally delivered repurposed drugs in periodontal tissue regeneration. Because of the multiple etiology of periodontitis, patients must get customized treatment with the primary goal of infection control. Yet, it is not always successful to replace the lost tissues, and it becomes more challenging as the defect gets worse. Pharmaceutical repurposing offers a viable, economical, and safe alternative for non-invasive, and predictable periodontal regeneration. This article clears the way in front of researchers, decision-makers, and pharmaceutical companies to explore the potential, effectiveness, and efficiency of the repurposed pharmaceuticals to generate more economical, effective, and safe topical pharmaceutical preparations for periodontal tissue regeneration.

Fabrication and Characterization of Electrospun Ocimum sanctum and Curcumin-Loaded Nanofiber Membrane for the Management of Periodontal Disease: An In Vitro Study

Background Periodontal disease is a chronic inflammatory condition that gradually deteriorates the supportive tissues of teeth, eventually leading to tooth loss. Mechanical debridement stands as the gold standard method for treating periodontitis. However, antimicrobial therapy is recommended for optimal results when used alongside mechanical debridement. Numerous studies have investigated local drug delivery as an adjunct to mechanical debridement of affected tooth surfaces. Ocimum sanctum exhibits anti-inflammatory, antioxidant, and antimicrobial properties. Similarly, curcumin, as documented in the literature, demonstrates a broad spectrum of anti-inflammatory and antimicrobial effects. Electrospinning has demonstrated itself to be a highly effective method for fabricating drug-loaded fibers. Electrospun nanofibers containing Ocimum sanctum and curcumin are expected to exhibit greater efficacy due to their increased surface area, facilitating the dispersion of larger quantities of drugs, and their ability to control drug release when employed as a local drug delivery system. This study aims to fabricate and characterize the properties of nanofiber membranes loaded with Ocimum sanctum and curcumin using the electrospinning technique. Methods About 50 mg each of Ocimum sanctum and curcumin were blended with 15% polyvinyl alcohol and 2% chitosan polymer in a 4:1 ratio and left to stir overnight. A 10 mL syringe was filled with this solution, and an 18 G blunt-end needle charged at 15.9 kV was used for extrusion. Continuous fibers were collected onto a collector plate positioned 12 cm from the center of the needle tip, at a flow rate of 0.005 mL/min. The morphology of the fabricated membrane was assessed through scanning electron microscopy (SEM), the strength of the material was assessed through tensile strength analysis using INSTRON, an Electropuls E3000 Universal Testing Machine (INSTRON, Norwood, MA), and the drug release pattern was analyzed using Jasco V-730 UV-visible spectrophotometer (Jasco, Easton, MD). Results The morphology of this nanofiber showed a random distribution of fibers with no bead formation. The average diameter of the membrane was 383±102 nm, and the tensile strength of this material was 1.87 MPa. The drug release pattern showed an initial burst release of Ocimum sanctum, followed by a controlled release in subsequent hours. However, curcumin showed very little drug release because of its solubility. Conclusion In summary, the Ocimum sanctum and curcumin-loaded nanofibers exhibited robust tensile strength, a controlled drug release profile, and uniform drug distribution within the nanofiber membrane. Consequently, it can be concluded that curcumin nanofibers and electrospun Ocimum sanctum serve as valuable agents for local drug delivery in the treatment of periodontitis.

Sustainable natural biopolymers for biomedical applications

Biopolymers are materials specifically engineered to interact with biological systems. They can be derived from either natural or synthetic sources, depending on the biological resources used or the manufacturing process employed. Over recent decades, these materials have gained significant popularity within the medical field due to their remarkable attributes such as biodegradability, bioactivity, and compatibility with human tissue. One notable application is their use as scaffolds for bone regeneration. Biopolymers, being renewable biomaterials, provide opportunities for continuous manufacturing and technological progress across various industries. These biomaterials have demonstrated great promise in medical sectors, including nerve regeneration and the production of surgical devices. Additionally, their versatility extends to non-biomedical applications, like food packaging. This paper aims to provide a comprehensive overview of different biopolymers, elucidating their properties, showcasing their latest applications, and delving into the state-of-the-art manufacturing technologies used in their production. Special emphasis is placed on their suitability as bone tissue repair and regeneration scaffolds, owing to their unique properties, which render them an ideal choice for this specific application.

Locally-Delivered 1% Metformin Gel as an Adjunct to Scaling and Root Planning in the Treatment of Severe Chronic Periodontitis: A Randomized, Controlled Clinical Trial

Background: Periodontitis is a chronic inflammatory disease that affects the teeth’s supporting structures, leading to clinical attachment loss, pocket formation, and tooth loss if left untreated. Scaling and root planning (SRP) is the gold standard for removing bacterial biofilm and calculus from tooth surfaces. However, in most situations, including tooth fractures, there is a need for adjunctive therapies to complement and improve treatment outcomes. This study aimed to evaluate the efficacy of locally delivered metformin (MF) 1% gel as an adjunct to SRP in treating severe chronic periodontitis. Materials and Methods: A total of 36 volunteers were randomly assigned to two treatment groups, namely, SRP plus placebo gel and SRP plus 1% MF gel. Clinical parameters such as pocket probing depth (PD), clinical attachment level (CAL), and gingival recession (GR) were recorded at baseline, 2, and 4 months. The data were analyzed using independent T-tests, one-way, and repeated measures analysis of variance (ANOVA) using SPSS 24 software. Results: All groups exhibited improvements in periodontal parameters such as PD and CAL. While the mean reductions in PD and CAL were not statistically significant after 3 weeks of treatment between the two groups (P=0.193), the MF group demonstrated significantly greater improvements in PD, measuring 3.49 mm compared to 1.87 mm in the control group (P=0.007), as well as in CAL, which measured 2.98 mm versus 1.72 mm in the control group (P=0.014). Conclusion: The adjunctive use of locally delivered 1% MF gel could stimulate a significant reduction in PD and increases in CAL compared to the placebo gel, while there was no GR resulting from the local delivery of the drug. This suggests that the MF gel may offer benefits in the treatment of severe chronic periodontitis by enhancing periodontal healing without inducing GR.

Comparative evaluation of propolis mouthwash with 0.2% chlorhexidine mouthwash as an adjunct to mechanical therapy in improving the periodontitis among perimenopausal women: a randomized controlled trial

OBJECTIVE

To evaluate the efficacy of Propolis mouthwash compared to chlorhexidine mouthwash as an adjunct to mechanical therapy in improving clinical parameters in perimenopausal women with chronic periodontitis.

METHODOLOGY

A double-blind, randomized, controlled clinical trial was conducted by recruiting 144 subjects with mild to moderate chronic periodontitis. After scaling and root planning, subjects were allocated to two treatment groups: 0.2% chlorhexidine mouthwash and 20% propolis mouthwash twice daily for six weeks. Clinical parameters such as pocket probing depth (PPD), clinical attachment loss (CAL) and bleeding on probing (BOP) were analysed at baseline, six weeks, and 12 weeks.

RESULT

The mean value of PPD in the propolis group was 4.67 at baseline, reduced to 4.01 at six weeks and 3.59 at 12 weeks. While in the chlorhexidine group, the baseline value of 4.65 reduced to 4.44 and 4.25 at six weeks and 12 weeks, respectively. The baseline value of the mean CAL in the propolis group was 4.45. This value was reduced to 4.15 at six weeks and 3.77 at 12 weeks. For the chlorhexidine group, the baseline value of CAL was 4.80, which was reduced to 4.50 and 4.19 at six weeks and 12 weeks. The mean value of bleeding on probing in the propolis group was 77.20, which decreased to 46.30 at six weeks and 14.60 at the final visit. In the chlorhexidine group, the mean value of 77.30 was reduced to 49.60 and 22.80 at subsequent visits.

CONCLUSION

This study concludes that both propolis and chlorhexidine mouthwash positively improve clinical parameters; however, propolis is significantly more effective in improving BOP.

TRIAL REGISTRATION

ID: NCT05870059, Date of Registration: 02/02/2022. ( https://beta.

CLINICALTRIALS

gov/study/NCT05870059 ).