Functional biomaterials for comprehensive periodontitis therapy

Periodontitis is an inflammatory disease caused by bacterial infection directly, and the dysregulation of host immune-inflammatory response finally destroys periodontal tissues. Current treatment strategies for periodontitis mainly involve mechanical scaling/root planing (SRP), surgical procedures, and systemic or localized delivery of antimicrobial agents. However, SRP or surgical treatment alone has unsatisfactory long-term effects and is easy to relapse. In addition, the existing drugs for local periodontal therapy do not stay in the periodontal pocket long enough and have difficulties in maintaining a steady, effective concentration to obtain a therapeutic effect, and continuous administration always causes drug resistance. Many recent studies have shown that adding bio-functional materials and drug delivery systems upregulates the therapeutic effectiveness of periodontitis. This review focuses on the role of biomaterials in periodontitis treatment and presents an overview of antibacterial therapy, host modulatory therapy, periodontal regeneration, and multifunctional regulation of periodontitis therapy. Biomaterials provide advanced approaches for periodontal therapy, and it is foreseeable that further understanding and applications of biomaterials will promote the development of periodontal therapy.

Descontaminação de boca toda e debridamento periodontal como alternativas para o tratamento da periodontite / Full-mouth disinfection and full-mouth debridement for treatment of periodontitis disease

O tratamento periodontal consiste na remoção das bactérias periodontopatogênicas, por meio de raspagem e alisamento radicular, cujos resultados são bastante satisfatórios. Contudo, o tratamento convencional por quadrantes além de ser longo, pode permitir a translocação bacteriana de uma região ainda não tratada para outra que já foi. Visando diminuir esses inconvenientes foi introduzida a descontaminação de boca toda: tratamento dentro de 24h e com uso intensivo de clorexidina. Uma modificação desse protocolo foi também sugerida: o debridamento da boca toda com o ultrassom - raspagem leve, em sessão única de 45 a 60 minutos e com o uso do aparelho de ultrassom. Essas novas abordagens, com e sem o uso de antissépticos, tem apresentado resultados semelhantes ao tratamento convencional, tornando-se, portanto, boas alternativas para o paciente com periodontite, trazendo vantagens em relação à duração e custo do tratamento, cabendo ao profissional e ao paciente a escolha da modalidade adequada.

Periodontal treatment consists of removal of periodontopathogens, through scaling and root planing, whose results are quite satisfactory. However, the conventional staged quadrant-wise scaling root planing approach besides being long, can allow bacterial translocation of untreated quadrant to another that has already been treated. Aiming to reduce such inconvenience was introduced the full-mouth disinfection: treatment within 24 hours and intensive use of chlorhexidine. A modification of the protocol was also suggested: full-mouth ultrasonic debridement: single session of ultrasonic instrumentation of 45 to 60 minutes. These new approaches, with and without the use of antiseptic, has produced results similar to conventional treatment, becoming therefore good alternatives to the patient with periodontitis, bringing advantages to the duration and cost of the treatment, giving the opportunity to the professional and the patient to choose the appropriate approach.

Short-term effect of COX-2 selective inhibitor as an adjunct for the treatment of periodontal disease: a clinical double-blind study in humans

Adjunctive therapeutic strategies that modulate the inflammatory mediators can play a significant role in periodontal therapy. In this double-blind, placebo-controlled study, 60 subjects diagnosed as periodontitis patients were evaluated for 28 days after periodontal treatment combined with selective cyclooxygenase-2 (COX-2) inhibitor. The experimental group received scaling and root planning (SRP) combined with the Loxoprofen antiinflammatory drug (SRP+Loxoprofen). The control group received SRP combined with placebo (SRP+placebo). Plaque index (PI), probing pocket depth (PD) and bleeding on probing (BOP) were monitored with an electronic probe at baseline and after 14 and 28 days. Both groups displayed clinical improvement in PD, PI and BOP. They also showed statistically similar values (p>0.05) of PD reduction on day 14 (0.4 mm) and on day 28 (0.6 mm). At the baseline, few deeper sites (>7 mm) from SRP+Loxoprofen group were responsible and most PD reduction was observed after 14 days (p<0.05). The percentage of remaining deep pockets (>7 mm) after 14 days in the SRP+Loxoprofen group was significantly lower (p<0.05) than in the SRP+placebo group. Loxoprofen presents potential effect as an adjunct of periodontal disease treatment, but long-term clinical trials are necessary to confirm its efficacy.

Estratégias terapêuticas adjuvantes que modulam os mediadores inflamatórios podem ter função significante na terapia periodontal. Neste estudo duplo-cego controlado com placebo, 60 indivíduos diagnosticados com periodontite foram avaliados por 28 dias após tratamento periodontal combinado com inibidor seletivo de COX-2. O grupo experimental foi tratado com raspagem e alisamento radicular combinado com medicação anti-inflamatória Loxoprofeno (RAR+Loxoprofen). O grupo controle foi tratado com raspagem e alisamento radicular combinado com medicação placebo (Raspagem e alisamento radicular - RAR+placebo). Presença de placa (PI), profundidade de sondagem (PS) e sangramento à sondagem (SS) foram monitoradas com auxílio de uma sonda computadorizada no início do estudo e após 14 e 28 dias. Os dois grupos demonstraram melhora clínica em relação a PS, PI e SS. Também foi observado valores semelhantes (p>0,05) de redução da PS nos períodos de 14 dias (0,4 mm) e 28 dias (0,6 mm). No início do estudo, alguns sítios profundos (>7 mm) do grupo RAR+Loxoprofen foram os responsáveis pela maior redução da PS depois de 14 dias (p<0,05). A porcentagem de bolsas periodontais profundas >7 mm após 14 dias no grupo RAR+Loxoprofen foi significativamente inferior do que o grupo RAR+placebo (p<0.05). A medicação Loxoprofen apresenta potencial efeito adjuvante à terapia periodontal, mas estudos de longo prazo são necessários para confirmar sua eficácia.