Proteolytic Nanoparticles Replace a Surgical Blade by Controllably Remodeling the Oral Connective Tissue.

Surgical blades are common medical tools. However, blades cannot distinguish between healthy and diseased tissue, thereby creating unnecessary damage, lengthening recovery, and increasing pain. We propose that surgical procedures can rely on natural tissue remodeling tools-enzymes, which are the same tools our body uses to repair itself. Through a combination of nanotechnology and a controllably activated proteolytic enzyme, we performed a targeted surgical task in the oral cavity. More specifically, we engineered nanoparticles that contain collagenase in a deactivated form. Once placed at the surgical site, collagenase was released at a therapeutic concentration and activated by calcium, its biological cofactor that is naturally present in the tissue. Enhanced periodontal remodeling was recorded due to enzymatic cleavage of the supracrestal collagen fibers that connect the teeth to the underlying bone. When positioned in their new orientation, natural tissue repair mechanisms supported soft and hard tissue recovery and reduced tooth relapse. Through the combination of nanotechnology and proteolytic enzymes, localized surgical procedures can now be less invasive.

Commentary on: periodontally accelerated osteogenic orthodontics (PAOO) - a clinical dilemma.

It is apparent that tooth movement is enhanced by procedures that elevate the remodeling of alveolar bone, and of periodontal and gingival fibrous tissues. The periodontally accelerated osteogenic orthodontics (PAOO) also termed as Wilckodontics, involves full-thickness labial and lingual alveolar flaps accompanied with limited selective labial and lingual surgical scarring of cortical bone (corticotomy). Most of the authors suggest that the RAP is the major stimulus for alveolar bone remodeling, enabling the PAOO. However, we propose that detachment of the bulk of dentogingival and interdental fibers from coronal part of root surfaces by itself should suffice to stimulate alveolar bone resorption mainly on its PDL surfaces, leading to widening of the periodontal ligament space which largely attributes to accelerated osteogenic orthodontics. Moreover this limited fiberotomy also disrupts transiently the positional physical memory of dentition (PPMD), allowing accelerated tooth movement. During retention period, a new biological and physical connectivity is generated that could be termed as new positional memory of the dental arch.