Nano-Based Drug Delivery Systems for Periodontal Tissue Regeneration

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.

New Advances in Periodontal Functional Materials Based on Antibacterial, Anti-Inflammatory, and Tissue Regeneration Strategies

With the global population aging, awareness of oral health is rising. Periodontitis, a widespread bacterial infectious disease, is gaining attention. Current novel biomaterials address key clinical issues like bacterial infection, gum inflammation, tooth loosening, and loss, focusing on antibacterial, anti-inflammatory, and tissue regeneration properties. However, strategies that integrate the advantages of these biomaterials to achieve synergistic therapeutic effects by clearing oral biofilms, inhibiting inflammation activation, and restoring periodontal soft and hard tissue functions remain very limited. Recent studies highlight the link between periodontitis and systemic diseases, underscoring the complexity of the periodontal disease. There is an urgent need to find comprehensive treatment plans that address clinical requirements. Whether by integrating new biomaterials to enhance existing periodontal treatments or by developing novel approaches to replace traditional therapies, these efforts will drive advancements in periodontitis treatment. Therefore, this review compares novel biomaterials with traditional treatments. It highlights the design concepts and mechanisms of these functional materials, focusing on their antibacterial, anti-inflammatory, and tissue regeneration properties, and discusses the importance of developing comprehensive treatment strategies. This review aims to provide guidance for emerging periodontitis research and to promote the development of precise and efficient treatment strategies.

Classification and bibliometric analysis of hydrogels in periodontitis treatment: Trends, mechanisms, advantages, and future research directions

OBJECTIVES

The review assess the potential of hydrogel-based drug delivery systems in treating periodontitis. Hydrogels are classified based on source, composition, configuration, crosslinking methods, ionic charge, and response to stimuli.

METHODS

The methodology comprised of comprehensive data collection from WoS, Scopus and PubMed databases covering the period of 2004-2024 of 626 documents. A bibliometric analysis was conducted using VOS Viewer to identify research trends, key contributors, prominent topics, and leading journals. A comparative analysis was performed to examine the benefits of hydrogels over conventional periodontitis treatments. Current research and innovations in hydrogel formulations were reviewed, including ongoing clinical trials and commercial products.

RESULTS

China was found to be the leading contributor to hydrogel research in periodontitis, with key topics including "hydrogels," "nanoparticles," and "drug delivery." A detailed classification system for hydrogels was established, aiding in their application for targeted drug delivery and tissue regeneration. Hydrogels were found to offer controlled drug release, support for tissue regeneration, and improved clinical outcomes compared to traditional treatments. Innovations highlighted including the use of various polymers like nano-hydroxyapatite/collagen composites, PLGA-based materials, and chitosan gels in clinical trials, demonstrating enhanced cell proliferation and tissue regeneration.

SIGNIFICANCE

This review underscores the significant potential of hydrogel-based therapies in advancing the treatment of periodontitis. By providing a comprehensive bibliometric analysis and highlighting key research and innovations, it emphasizes the advantages of hydrogels in terms of targeted drug delivery, minimal invasiveness, and support for tissue regeneration. The findings suggest that with further clinical trials and regulatory approvals, hydrogels could become a mainstream, effective treatment option for periodontitis, offering improved patient outcomes and potentially transforming periodontal therapy.

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.

Microbiological evaluation of vitamin C rich acerola mediated silver and copperoxide nanogel in treatment of periodontitis with and without diabetes mellitus

Aim

Nanotechnology presents a promising approach for managing chronic periodontitis, a common oral disease characterized by gum inflammation and loss of supporting bone around teeth. This study aimed to evaluate the antimicrobial efficacy of acerola-mediated silver nanoparticles (AgNPs) gel and copper oxide nanoparticles (CuONPs) gel in periodontitis patients with and without diabetes.

Materials and methods

The antimicrobial efficacy of acerola-mediated AgNPs gel and CuONPs nanogel was assessed using the agar well diffusion technique, Minimum Inhibitory Concentration (MIC) assay, Minimum Bactericidal Concentration (MBC) analysis, time-kill curve assay, and cytoplasmic and protein leakage analysis from periodontitis patients with and without diabetes.

Results

The study found that acerola-mediated AgNPs gel demonstrated more consistent and effective antimicrobial activity against periodontitis, with lower MIC and MBC values compared to the CuONPs gel, across all tested concentrations. These results suggest that acerola-mediated AgNPs gel may be a more effective and targeted therapeutic agent for periodontal disease management.

Conclusion

The findings emphasize the importance of nanoparticle gel concentration in optimizing periodontal treatment outcomes. Acerola-mediated AgNPs gel, with its superior efficacy and consistency in bactericidal activity, shows significant potential for periodontal therapy.

Clinical significance

Innovative nanoparticles like copper and silver oxides exhibit antibacterial, anti-inflammatory, and antioxidant properties, making them promising agents for targeting periodontal pathogens. Acerola (Malpighia emarginata), with its high vitamin C content and antioxidant properties, is beneficial in mitigating oxidative stress associated with chronic periodontitis.

Biomaterial Scaffolds for Periodontal Tissue Engineering

Advanced periodontitis poses a significant threat to oral health, causing extensive damage and loss of both hard and soft periodontal tissues. While traditional therapies such as scaling and root planing can effectively halt the disease's progression, they often fail to fully restore the original architecture and function of periodontal tissues due to the limited capacity for spontaneous regeneration. To address this challenge, periodontal tissue engineering has emerged as a promising approach. This technology centers on the utilization of biomaterial scaffolds, which function as three-dimensional (3D) templates or frameworks, supporting and guiding the regeneration of periodontal tissues, including the periodontal ligament, cementum, alveolar bone, and gingival tissue. These scaffolds mimic the extracellular matrix (ECM) of native periodontal tissues, aiming to foster cell attachment, proliferation, differentiation, and, ultimately, the formation of new, functional periodontal structures. Despite the inherent challenges associated with preclinical testing, the intensification of research on biomaterial scaffolds, coupled with the continuous advancement of fabrication technology, leads us to anticipate a significant expansion in their application for periodontal tissue regeneration. This review comprehensively covers the recent advancements in biomaterial scaffolds engineered specifically for periodontal tissue regeneration, aiming to provide insights into the current state of the field and potential directions for future research.

Suppressing ERp57 diminishes osteoclast activity and ameliorates ovariectomy-induced bone loss via the intervention in calcium oscillation and the calmodulin/calcineurin/Nfatc1 pathway

Background

Increased osteoclast activity constitutes the primary etiology of excessive bone erosion in postmenopausal osteoporosis. ERp57, otherwise referred to as protein disulfide isomerase A3 (PDIA3), plays a crucial role in the regulation of intracellular calcium signaling. This is documented to exert a profound impact on osteoclast differentiation and functionality.

Methods

To ascertain the potential role of ERp57 in disease progression, prevention, and treatment, network pharmacology and bioinformatics analyses were conducted in relation to postmenopausal osteoporosis and ERp57 inhibitor (Loc14). Then, subsequent experimental verifications were employed in vitro on osteoclast and osteoblast, and in vivo on ovariectomy (OVX) mice models.

Results

Multiple enrichment analyses suggested that the "calcium signaling pathway" may constitute a potential avenue for therapeutic intervention by Loc14 in the treatment of postmenopausal osteoporosis. In vitro experiments demonstrated inhibition of ERp57 could block osteoclast differentiation and function by interfering with the expression of osteoclast marker genes (Traf6, Nfatc1, and Ctsk). Further mechanisms studies based on calcium imaging, qPCR, and WB established that ERp57 inhibitor (Loc14) could obstruct calcium oscillation in osteoclast precursor cells (OPCs) by limiting the entry sources of cytosolic Ca2+ and interfering with calmodulin/calcineurin/Nfatc1 pathway. Evidence from Micro-CT scanning and double calcein labeling confirmed that the application of Loc14 in vivo could alleviate bone loss and partially reversed the osteogenic impairment caused by OVX in mice.

Conclusions

Our findings proved the suppressive effects of Loc14 on osteoclastogenesis via attenuating calcium oscillation and associated singling pathways, providing ERp57 as a potential therapeutic target for postmenopausal osteoporosis.

Natural Bioactive Compounds in the Management of Periodontal Diseases: A Comprehensive Review

Periodontal diseases, chronic inflammatory conditions affecting oral health, are primarily driven by microbial plaque biofilm and the body's inflammatory response, leading to tissue damage and potential tooth loss. These diseases have significant physical, psychological, social, and economic impacts, necessitating effective management strategies that include early diagnosis, comprehensive treatment, and innovative therapeutic approaches. Recent advancements in biomanufacturing have facilitated the development of natural bioactive compounds, such as polyphenols, terpenoids, alkaloids, saponins, and peptides, which exhibit antimicrobial, anti-inflammatory, and tissue regenerative properties. This review explores the biomanufacturing processes-microbial fermentation, plant cell cultures, and enzymatic synthesis-and their roles in producing these bioactive compounds for managing periodontal diseases. The integration of these natural compounds into periodontal therapy offers promising alternatives to traditional treatments, potentially overcoming issues like antibiotic resistance and the disruption of the natural microbiota, thereby improving patient outcomes.

Enhancing periodontal defences with nanofiber treatment: recent advances and future prospects

The term periodontal disease is used to define diseases characterised by inflammation and regeneration of the gums, cementum, supporting bone, and periodontal ligament. The conventional treatment involves the combination of scaling, root planning, and surgical approaches which are invasive and can pose certain challenges. Intrapocket administration of nanofibers can be used for overcoming challenges which can help in speeding up the wound repair process and can also be used to promote osteogenesis. To help make drug delivery more effective, nanofibers are an interesting solution. Nanofibers are nanosized 3D structures that can fill the pockets and have excellent mucoadhesion which prolongs their retention time on the target site. Moreover, their structure mimics the natural extracellular matrix which enables nanomaterials to sense local biological conditions and start cellular-level reprogramming to produce the necessary therapeutic efficacy. In this review, the significance of intrapocket administration of nanofibers using recent research for the management of periodontitis has been discussed in detail. Furthermore, we have discussed polymers used for the preparation of nanofibers, nanofiber production methods, and the patents associated with these developments. This comprehensive compilation of data serves as a valuable resource, consolidating recent developments in nanofiber applications for periodontitis management into one accessible platform.

Effect of chitosan/dioleyl phosphatidyl ethanolamine - Baicalein nanohydrogel in the treatment of rat with periodontitis

Objective

this work aimed to investigate the effectiveness of chitosan (CS)/dioleyl phosphatidyl ethanolamine (DOPE) - baicalein (CS/DOPE-BAE) nanohydrogel as a novel drug delivery system for the treatment of periodontitis in rats.

Materials and methods

the CS/DOPE-BAE nanohydrogel was synthesized and characterized for its morphology, particle size (PS), drug loading, and release properties. A rat periodontitis model was established, and the rats were randomly assigned to four groups, receiving treatment of normal saline, CS/DOPE blank nanohydrogel, baicalein solution, and CS/DOPE-BAE nanohydrogel through local injection, respectively. Clinical symptoms, periodontal tissue morphology, and the levels of interleukin (IL)-1β, tumor necrosis factor-α (TNF-α), and IL-10 in the periodontal tissue were observed and compared.

Results

the CS/DOPE-BAE nanohydrogel exhibited a spherical shape with a PS of approximately 200 nm and a drug loading of 8.6 %. It demonstrated excellent sustained-release properties. The group treated with CS/DOPE-BAE nanohydrogel showed significant improvement in clinical symptoms, such as reduced gingival redness and bleeding in rats, decreased inflammatory cell infiltration, and weakened fibroblast proliferation in the periodontal tissue. Additionally, IL-1β and TNF-α levels were downregulated, while IL-10 level was elevated.

Conclusion

the CS/DOPE-BAE nanohydrogel was an effective baicalein delivery system that can inhibit the progression of periodontitis, improve the inflammatory response in periodontal tissue, and deliver promising therapeutic effects.

Spotlight on therapeutic efficiency of green synthesis metals and their oxide nanoparticles in periodontitis

Periodontitis, one of the most prevalent dental diseases, causes the loss of bone and gum tissue that hold teeth in place. Several bacteria, commonly present in clinically healthy oral cavities, may induce and perpetuate periodontitis when their concentration rises in the gingival sulcus. Antibacterial effect against various Gram-negative and Gram-positive bacteria, including pathogenic and drug-resistant ones, has been shown for several distinct transient metal and metal oxide NPs. Therefore, NPs may be used in biomedicine to treat periodontal problems and in nanotechnology to inhibit the development of microorganisms. Instead of using harmful chemicals or energy-intensive machinery, biosynthesis of metal and metal oxide nanoparticles (NPs) has been suggested. To produce metal and metal oxide NPs, the ideal technique is "Green" synthesis because of its low toxicity and safety for human health and the environment. Gold NPs (AuNPs) appear to be less toxic to mammalian cells than other nanometals because their antibacterial activity is not dependent on reactive oxygen species (ROS). AgNPs also possess chemical stability, catalytic activity, and superior electrical and thermal conductivity, to name a few of their other advantageous characteristics. It was observed that zinc oxide (ZnO) NPs and copper (Cu) NPs exhibited discernible inhibitory effects against gram-positive and gram-negative bacterial strains, respectively. ZnO NPs demonstrated bactericidal activity against the microorganisms responsible for periodontitis. Medications containing magnetic NPs are highly effective against multidrug-resistant bacterial and fungal infections. The titanium dioxide (TiO2) NPs are implicated in elevating salivary peroxidase activity in individuals diagnosed with chronic periodontitis. Furthermore, specific metallic NPs have the potential to enhance the antimicrobial efficacy of periodontitis treatments when combined. Therefore, these NPs, as well as their oxide NPs, are only some of the metals and metal oxides that have been synthesized in environmentally friendly ways and shown to have therapeutic benefits against periodontitis.

Photodynamic therapy empowered by nanotechnology for oral and dental science: Progress and perspectives

Photodynamic therapy (PDT), as a noninvasive therapeutic modality, has significantly revolutionized the contemporary management of oral and dental health. Recently, PDT has witnessed significant technological advancements, especially with the introduction of biomaterials and nanotechnologies, thus highlighting its potential as a multi-functional tool in therapeutics. In this review, our objective was to provide a comprehensive overview of the advancements in nanotechnology-enhanced PDT for the treatment of oral diseases, encompassing dental caries, root canal infection, periodontal disease, peri-implant inflammation, tooth staining, and whitening, as well as precancerous lesions and tumors. Furthermore, we extensively deliberated upon the persisting challenges and prospective avenues of nanotechnology-enhanced PDT in the realm of oral diseases, which will open up new possibilities for the application of nanotechnology-enhanced PDT in clinical implementation.

Functional Surface Coatings on Orthodontic Appliances: Reviews of Friction Reduction, Antibacterial Properties, and Corrosion Resistance

Surface coating technology is an important way to improve the properties of orthodontic appliances, allowing for reduced friction, antibacterial properties, and enhanced corrosion resistance. It improves treatment efficiency, reduces side effects, and increases the safety and durability of orthodontic appliances. Existing functional coatings are prepared with suitable additional layers on the surface of the substrate to achieve the abovementioned modifications, and commonly used materials mainly include metal and metallic compound materials, carbon-based materials, polymers, and bioactive materials. In addition to single-use materials, metal-metal or metal-nonmetal materials can be combined. Methods of coating preparation include, but are not limited to, physical vapor deposition (PVD), chemical deposition, sol-gel dip coating, etc., with a variety of different conditions for preparing the coatings. In the reviewed studies, a wide variety of surface coatings were found to be effective. However, the present coating materials have not yet achieved a perfect combination of these three functions, and their safety and durability need further verification. This paper reviews and summarizes the effectiveness, advantages and disadvantages, and clinical perspectives of different coating materials for orthodontic appliances in terms of friction reduction, antibacterial properties, and enhanced corrosion resistance, and discusses more possibilities for follow-up studies as well as for clinical applications in detail.

Nanomaterials: an intra-periodontal pocket drug-delivery system for periodontitis

Periodontitis is a microbiological condition that affects the tissues supporting the teeth. The fundamental to effective periodontal therapy is choosing the suitable antimicrobial and anti-inflammatory agent, together with the proper route of drug administration and delivery system. Intra-periodontal pocket approach with nano drug-delivery systems (NDDS) such as polymeric nanoparticles, gold nanoparticles, silica nanoparticles, magnetic nanoparticles, liposomes, polymersomes, exosomes, nano micelles, niosome, solid lipid nanoparticles, nano lipid carriers, nanocomposites, nanogels, nanofibers, scaffolds, dendrimers, quantum dots, etc., will be appropriate route of drug administration and delivery system. This NDDS delivers the drugs at the site of infection to inhibit growth and promote tissue regeneration. The present review focused on providing comprehensive information on the NDDS for periodontitis, which enhanced therapeutic outcomes via intra-periodontal pocket delivery.

Recent Advances in Intranasal Liposomes for Drug, Gene, and Vaccine Delivery

Liposomes are safe, biocompatible, and biodegradable spherical nanosized vesicles produced from cholesterol and phospholipids. Recently, liposomes have been widely administered intranasally for systemic and brain delivery. From the nasal cavity, liposome-encapsulated drugs and genes enter the systemic circulation primarily via absorption in the respiratory region, whereas they can be directly transported to the brain via the olfactory pathway. Liposomes can protect drugs and genes from enzymatic degradation, increase drug absorption across the nasal epithelium, and prolong the residence time in the nasal cavity. Intranasal liposomes are also a potential approach for vaccine delivery. Liposomes can be used as a platform to load antigens and as vaccine adjuvants to induce a robust immune response. With the recent interest in intranasal liposome formulations, this review discusses various aspects of liposomes that make them suitable for intranasal administration. We have summarized the latest advancements and applications of liposomes and evaluated their performance in the systemic and brain delivery of drugs and genes administered intranasally. We have also reviewed recent advances in intranasal liposome vaccine development and proposed perspectives on the future of intranasal liposomes.

Treated Dentin Matrix in Tissue Regeneration: Recent Advances

Tissue engineering is a new therapeutic strategy used to repair serious damage caused by trauma, a tumor or other major diseases, either for vital organs or tissues sited in the oral cavity. Scaffold materials are an indispensable part of this. As an extracellular-matrix-based bio-material, treated dentin matrixes have become promising tissue engineering scaffolds due to their unique natural structure, astonishing biological induction activity and benign bio-compatibility. Furthermore, it is important to note that besides its high bio-activity, a treated dentin matrix can also serve as a carrier and release controller for drug molecules and bio-active agents to contribute to tissue regeneration and immunomodulation processes. This paper describes the research advances of treated dentin matrixes in tissue regeneration from the aspects of its vital properties, biologically inductive abilities and application explorations. Furthermore, we present the concerning challenges of signaling mechanisms, source extension, individualized 3D printing and drug delivery system construction during our investigation into the treated dentin matrix. This paper is expected to provide a reference for further research on treated dentin matrixes in tissue regeneration and better promote the development of relevant disease treatment approaches.