Periodontal effects of maxillary expansion in adults using non-surgical expanders with skeletal anchorage vs. surgically assisted maxillary expansion: a systematic review.

OBJECTIVES: Describe and compare harmful periodontal effects as a consequence of maxillary expansion in adult patients with different types of anchorage devices in non-surgical expanders with skeletal anchorage and surgically assisted maxillary expansion. MATERIALS AND METHODS: An exhaustive search was carried out on the electronic databases PubMed (MEDLINE), Embase, Cochrane and LILACS. Additionally, journal references and grey literature were searched without any restrictions. After the selection and extraction process; risk of bias was assessed by the ROB-1 Cochrane tool and Newcastle-Ottawa Scale (NOS) for randomized trials and cohort studies, respectively. RESULTS: Of 621 studies retrieved from the searches, six were finally included in this review. One of them presented a low risk bias, while five were excellent respective to selection, comparability and outcomes. Results showed that maxillary expansion in adults using non-surgical expanders (bone-borne or tooth-bone-borne with bicortical skeletal anchorage) produce less harmful periodontal effects, such as: alveolar bending with an average range from 0.92° to 2.32°, compared to surgically assisted maxillary expansion (tooth-borne) of 6.4°; dental inclination with an average range from 0.07° to 2.4°, compared to surgically assisted maxillary expansion (tooth-borne) with a range from 2.01° to 5.56°. CONCLUSIONS: Although limited, the current evidence seems to show that the bone-borne or tooth-bone-borne with bicortical skeletal anchorage produces fewer undesirable periodontal effects.

Multifunctional nanocarriers for the treatment of periodontitis: Immunomodulatory, antimicrobial, and regenerative strategies.

Periodontitis is an inflammatory disease, in which the host immuno-inflammatory response against the dysbiotic subgingival biofilm leads to the breakdown of periodontal tissues. Most of the available treatments seem to be effective in the short-term; nevertheless, permanent periodical controls and patient compliance compromise long-term success. Different strategies have been proposed for the modulation of the host immune response as potential therapeutic tools to take a better care of most susceptible periodontitis patients, such as drug local delivery approaches. Though, maintaining an effective drug concentration for a prolonged period of time has not been achieved yet. In this context, advanced drug delivery strategies using biodegradable nanocarriers have been proposed to avoid toxicity and frequency-related problems of treatment. The versatility of distinct nanocarriers allows the improvement of their loading and release capabilities and could be potentially used for microbiological control, periodontal regeneration, and/or immunomodulation. In the present review, we revise and discuss the most frequent biodegradable nanocarrier strategies proposed for the treatment of periodontitis, including polylactic-co-glycolic acid (PLGA), chitosan, and silica-derived nanoparticles, and further suggest novel therapeutic strategies.