Brazilin cream from Caesalpinia sappan inhibit periodontal disease: in vivo study.

Background: Gingivitis is an inflammation of the gums that is the initial cause of the development of periodontal disease by the activity of Nuclear Factor-kappa B (NF-κB), Interleukin-1ß (IL-1ß), Interleukin-6 (IL-6), p38, and Tumor Necrosis Factor-α (TNF-α). Unaddressed chronic inflammation can lead to persistent disturbances in other parts of the body. Brazilin is a naturally occurring plant chemical that may have antibacterial and anti-inflammatory effects. Treatment based on the natural plant compound, brazilin, is developed in the form of a topical cream for easy application. Objective: The aim is to develop the natural compound brazilin in the form of a topical cream as an anti-inflammatory agent to reduce NF-κB expression through Imunohistochemistry (IHC) methods, and the expression of pro-inflammatory genes IL-1ß, IL-6, p38, and TNF-α. Methods: Male Sprague-Dawley rats were induced with gingivitis using P. gingivalis bacteria. The observed groups included rats treated with a single application of brazilin cream and rats treated with two applications of brazilin cream. The treatment was administered for 15 days. On days 3, 6, 9, 12, and 15, anatomical wound observations and wound histology using hematoxylin-eosin and Masson's Trichrome staining were performed. NF-κB protein expression was analyzed using the IHC method. Gingival inflammation gene expression of NF-κB, IL-1ß, IL-6, p38, and TNF-α was measured using q-RTPCR. Results: Single and double applications of brazilin cream increased angiogenesis and decreased NF-κB protein expression, in addition to the IL-1ß, IL-6, p38, and TNF-α gene expressions. Conclusion: In a rat gingivitis model, Brazilin cream may function as an anti-inflammatory agent in the gingival tissue.

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.

Adjunctive antimicrobial photodynamic therapy for treating periodontal and peri-implant diseases.

BACKGROUND: Periodontitis and peri-implant diseases are chronic inflammatory conditions occurring in the mouth. Left untreated, periodontitis progressively destroys the tooth-supporting apparatus. Peri-implant diseases occur in tissues around dental implants and are characterised by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone. Treatment aims to clean the pockets around teeth or dental implants and prevent damage to surrounding soft tissue and bone, including improvement of oral hygiene, risk factor control (e.g. encouraging cessation of smoking) and surgical interventions. The key aspect of standard non-surgical treatment is the removal of the subgingival biofilm using subgingival instrumentation (SI) (also called scaling and root planing). Antimicrobial photodynamic therapy (aPDT) can be used an adjunctive treatment to SI. It uses light energy to kill micro-organisms that have been treated with a light-absorbing photosensitising agent immediately prior to aPDT. OBJECTIVES: To assess the effects of SI with adjunctive aPDT versus SI alone or with placebo aPDT for periodontitis and peri-implant diseases in adults. SEARCH METHODS: We searched the Cochrane Oral Health Trials Register, CENTRAL, MEDLINE, Embase, two other databases and two trials registers up to 14 February 2024. SELECTION CRITERIA: We included randomised controlled trials (RCTs) (both parallel-group and split-mouth design) in participants with a clinical diagnosis of periodontitis, peri-implantitis or peri-implant disease. We compared the adjunctive use of antimicrobial photodynamic therapy (aPDT), in which aPDT was given after subgingival or submucosal instrumentation (SI), versus SI alone or a combination of SI and a placebo aPDT given during the active or supportive phase of therapy. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodological procedures, and we used GRADE to assess the certainty of the evidence. We prioritised six outcomes and the measure of change from baseline to six months after treatment: probing pocket depth (PPD), bleeding on probing (BOP), clinical attachment level (CAL), gingival recession (REC), pocket closure and adverse effects related to aPDT. We were also interested in change in bone level (for participants with peri-implantitis), and participant satisfaction and quality of life. MAIN RESULTS: We included 50 RCTs with 1407 participants. Most studies used a split-mouth study design; only 18 studies used a parallel-group design. Studies were small, ranging from 10 participants to 88. Adjunctive aPDT was given in a single session in 39 studies, in multiple sessions (between two and four sessions) in 11 studies, and one study included both single and multiple sessions. SI was given using hand or power-driven instrumentation (or both), and was carried out prior to adjunctive aPDT. Five studies used placebo aPDT in the control group and we combined these in meta-analyses with studies in which SI alone was used. All studies included high or unclear risks of bias, such as selection bias or performance bias of personnel (when SI was carried out by an operator aware of group allocation). We downgraded the certainty of all the evidence owing to these risks of bias, as well as for unexplained statistical inconsistency in the pooled effect estimates or for imprecision when evidence was derived from very few participants and confidence intervals (CI) indicated possible benefit to both intervention and control groups. Adjunctive aPDT versus SI alone during active treatment of periodontitis (44 studies) We are very uncertain whether adjunctive aPDT during active treatment of periodontitis leads to improvement in any clinical outcomes at six months when compared to SI alone: PPD (mean difference (MD) 0.52 mm, 95% CI 0.31 to 0.74; 15 studies, 452 participants), BOP (MD 5.72%, 95% CI 1.62 to 9.81; 5 studies, 171 studies), CAL (MD 0.44 mm, 95% CI 0.24 to 0.64; 13 studies, 414 participants) and REC (MD 0.00, 95% CI -0.16 to 0.16; 4 studies, 95 participants); very low-certainty evidence. Any apparent differences between adjunctive aPDT and SI alone were not judged to be clinically important. Twenty-four studies (639 participants) observed no adverse effects related to aPDT (moderate-certainty evidence). No studies reported pocket closure at six months, participant satisfaction or quality of life. Adjunctive aPDT versus SI alone during supportive treatment of periodontitis (six studies) We were very uncertain whether adjunctive aPDT during active treatment of periodontitis leads to improvement in any clinical outcomes at six months when compared to SI alone: PPD (MD -0.04 mm, 95% CI -0.19 to 0.10; 3 studies, 125 participants), BOP (MD 4.98%, 95% CI -2.51 to 12.46; 3 studies, 127 participants), CAL (MD 0.07 mm, 95% CI -0.26 to 0.40; 2 studies, 85 participants) and REC (MD -0.20 mm, 95% CI -0.48 to 0.08; 1 study, 24 participants); very low-certainty evidence. These findings were all imprecise and included no clinically important benefits for aPDT. Three studies (134 participants) reported adverse effects: a single participant developed an abscess, though it is not evident whether this was related to aPDT, and two studies observed no adverse effects related to aPDT (moderate-certainty evidence). No studies reported pocket closure at six months, participant satisfaction or quality of life. AUTHORS' CONCLUSIONS: Because the certainty of the evidence is very low, we cannot be sure if adjunctive aPDT leads to improved clinical outcomes during the active or supportive treatment of periodontitis; moreover, results suggest that any improvements may be too small to be clinically important. The certainty of this evidence can only be increased by the inclusion of large, well-conducted RCTs that are appropriately analysed to account for change in outcome over time or within-participant split-mouth study designs (or both). We found no studies including people with peri-implantitis, and only one study including people with peri-implant mucositis, but this very small study reported no data at six months, warranting more evidence for adjunctive aPDT in this population group.

Antimicrobial management of dental infections: Updated review.

Dental infections, which include anything from severe periodontal illnesses and abscess forms to routine tooth caries, are a major public health risk. This review article focuses on the pathophysiology and treatment of dental infections. A narrative review was conducted based on several published articles, relevant journals, and books in Google Scholar PubMed using the keywords dental caries, periodontal disease, gingivitis, and related diseases; we excluded duplicated information. Our review illustrated the types of dental infections and the proper antimicrobial drug that is suitable for this disease. Drawing from recent research findings and clinical evidence, we explore the spectrum of bacteria commonly associated with dental infections and their susceptibility profiles to various antibiotics. Emphasis is placed on understanding the mechanisms of antibiotic action and resistance in the context of dental pathogens, shedding light on optimal treatment regimens and potential challenges in clinical management. Additionally, we go over the clinical consequences of antibiotic therapy in dentistry, taking into account factors like patient selection, dose guidelines, and side effects. The management of dental infections through antimicrobial strategies has undergone significant advancements, as evidenced by this updated review. Besides the normal methods, emerging technologies such as 3D printing for drug delivery of antibiotics and disinfectants hold promise in enhancing treatment efficacy and patient outcomes. By leveraging the precision and customization afforded by 3D printing, dentistry can tailor antimicrobial interventions to individual patient needs, optimizing therapeutic outcomes while minimizing adverse effects.

Salvadora persica leaves: phytochemical profile and in vitro-inhibitory activity on inflammatory mediators implicated in periodontal disease.

CONTEXT: Virtually all parts of Salvadora persica L. (Salvadoraceae) are used in traditional medicine. The twigs and leaves are used for oral health, but leaves are far less investigated. OBJECTIVE: This study assesses the oral health-promoting potential of S. persica leaves with emphasis on anti-inflammatory and antiproliferative effects and provides an in depth-characterization of their metabolite profile. MATERIALS AND METHODS: Hot-water and methanolic S. persica leaf extracts (1, 10, and 100 µg/mL) and their major constituents (5, 10, and 50 µM), were subjected to cellular assays on IL-8 and TNFα release in LPS-stimulated human neutrophils, NO-release in LPS/IFNγ stimulated mouse macrophages, and proliferation of HNO97 human tongue carcinoma cells. Metabolite profiling was performed by UHPLC-HRMS analysis. Major constituents were isolated and structurally elucidated. RESULTS AND DISCUSSION: Both extracts showed pronounced anti-inflammatory activity in LPS-stimulated neutrophils. Major identified compound classes were flavonoid glycosides, the glucosinolate glucotropaeolin, phenyl- and benzylglycoside sulfates, and megastigmane glycosylsulfates, the latter ones identified for the first time in S. persica. Glucotropaeolin strongly inhibited the release of IL-8 and TNF-α (13.3 ± 2.0 and 22.7 ± 2.6% of the release of stimulated control cells at 50 µM), while some flavonoids and 3-(3'-O-sulfo-ß-d-glucopyranosyloxy)-7,8-dihydro-ß-ionone, a newly isolated megastigmane glycosylsulfate, were moderately active. Benzylisothiocyanate, which is likely formed from glucotropaeolin during traditional application of S. persica, showed considerable antiproliferative activity (IC50 in HNO97 cells: 10.19 ± 0.72 µM) besides strongly inhibiting IL-8 and TNFα release. CONCLUSIONS: Glucotropaeolin and benzylisothiocyanate are likely implicated in the oral health-promoting effects of S. persica leaves. The chemistry and pharmacology of the newly identified megastigmane glycosylsulfates should be further evaluated.

The Effect of Local Application of Tea Tree Oil Adjunctive to Daily Oral Maintenance and Nonsurgical Periodontal Treatment: A Systematic Review and Meta-Analysis of Randomised Controlled Studies.

PURPOSE: To evaluate the efficacy of the adjunctive use of tea tree oil (TTO) for dental plaque control and nonsurgical periodontal treatment (NSPT). MATERIALS AND METHODS: Three electronic databases were searched from 2003. The reference lists of the included articles and relevant reviews were also manually searched. Randomised controlled trials reporting the clinical outcomes of the topical use of TTO as an adjunct to daily oral hygiene or scaling and root planing (SRP) were included. Regarding the use of TTO as an adjunctive to daily oral hygiene, the primary outcome was plaque index (PI) reduction. Regarding the use of TTO as an adjunctive to SRP, probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain were the primary outcomes. The secondary outcomes were adverse events. RESULTS: Eleven studies were included for qualitative analysis, 9 studies were included for quantitative analysis, and 6 studies were included to examine the application of TTO mouthwash as an adjunctive to daily oral hygiene. In addition, three studies were included to analyse the subgingival use of TTO adjunctive to SRP at selected sites. The results indicated a nonsignificant improvement in PI reduction in the TTO mouthwash group compared with placebo. The incidence of adverse events was statistically significantly greater in the CHX group than in the TTO group. For subgingival use of TTO adjunctive to SRP, beneficial effects were observed in the TTO group compared with SRP alone in terms of PPD and CAL at both three and six months post-treatment. However, an unpleasant taste was reported in three out of four studies. CONCLUSION: There is a lack of strong evidence to support the beneficial effects of TTO. Studies with larger sample sizes and standardised evaluation criteria are needed to further demonstrate the clinical relevance of TTO.

Encapsulation of Alpinia leaf essential oil in nanophytosome-embedded gel as novel strategy to treat periodontal infections: evaluation of antimicrobial effectiveness, pharmacokinetic, in vitro-ex vivo correlation and in silico studies.

AIM: The work reports a novel nanophytosomal gel encapsulating Alpinia galanga (L.) Willd leaf essential oil to treat periodontal infections. METHODS: Alpinia oil-loaded nanophytosomes (ANPs) were formulated by lipid layer hydration technique and were evaluated by FESEM, cryo-TEM, loading efficiency, zeta potential, particle size, release profile etc. Selected ANPs-loaded gel (ANPsG) was evaluated by both in vitro and in vivo methods. RESULTS: Selected ANPs were spherical, unilamellar, 49.32 ± 2.1 nm size, 0.45 PDI, -46.7 ± 0.8 mV zeta potential, 9.8 ± 0.5% (w/w) loading, 86.4 ± 3.02% (w/w) loading efficiency with sustained release profile. ANPsG showed good spreadability (6.8 ± 0.3 gm.cm/sec), extrudability (79.33 ± 1.5%), viscosity (36522 ± 0.82 cps), mucoadhesive strength (44.56 ± 3.5 gf) with sustained ex vivo release tendency. Satisfied ZOI and MIC was observed for ANPsG against periodontal bacteria vs. standard/control. ANPsG efficiently treated infection in ligature induced periodontitis model. Key pharmacokinetic parameters like AUC, MRT, Vd were enhanced for ANPsG. CONCLUSION: ANPsG may be investigated for futuristic clinical studies.

Therapeutic Potential of Ginsenosides on Bone Metabolism: A Review of Osteoporosis, Periodontal Disease and Osteoarthritis.

Ginsenosides, bioactive compounds from the genus Panax, have potential therapeutic effects on diverse ailments, including diabetes. Emerging evidence suggests their involvement in bone metabolism. The present review summarizes the current understanding of the effects of ginsenosides on osteoporosis, periodontal disease, and osteoarthritis. Their mechanisms of action include effects on osteoblasts, osteoclasts, periodontal ligament fibroblasts (PDLFs), and chondrocytes, which are pivotal in maintaining bone, periodontal tissue, and cartilage homeostasis. Ginsenosides may exert their beneficial effects by enhancing PDLF and osteoblast activity, suppressing osteoclast function, augmenting chondrocyte synthesis in the cartilage matrix, and mitigating connective tissue degradation. Moreover, they possess antioxidant, anti-inflammatory, antimicrobial, and anti-pyroptotic properties. Their efficacy in increasing bone density, ameliorating periodontitis, and alleviating osteoarthritis symptoms has been demonstrated in preclinical studies using animal models. In terms of their mechanism of action, ginsenosides modulate cellular differentiation, activity, and key signaling pathway molecules, such as mitogen-activated protein kinases (MAPKs), while also regulating various mediators. Furthermore, the symptomatic relief observed in animal models lends further credence to their therapeutic utility. However, to translate these preclinical findings into clinical practice, rigorous animal and clinical investigations are imperative to ascertain the safety, efficacy, and optimal dosing regimens in human subjects.

Multi-nutrients and periodontal disease - a new adjunct to improving treatment outcomes? A randomised placebo-control clinical trial.

DESIGN: This study by Laky et al. is a single-centre, double-blinded randomised placebo-controlled clinical trial, examining the effects of micronutrient supplementation in combination with non-surgical hygiene phase therapy (nsHPT) for Stage III and IV periodontal disease. The study was carried out at the Medical University of Vienna (Austria), School of Dentistry. The patients enrolled in the study were randomised to receive a commercially available multi-nutrient supplement (containing: vitamin C, vitamin E, zinc, selenium, alpha-lipoic-acid, cranberry extract, grapeseed extract, and coenzyme Q10) or a cellulose placebo to take for 2 months, alongside a course of non-surgical hygiene phase therapy. At baseline, the patients had a periodontal index screening (PSI) performed. Patients scoring >3 and meeting the inclusion criteria were enrolled in the trial. Oral hygiene instruction and patient education was performed, followed by 1 or more sessions of nsHPT depending on the clinical assessment of each patient, and a full periodontal probing depth (PPD) chart was recorded. The patients were then randomised to receive either the multi-nutrient supplement or the placebo to take twice daily for 8 weeks. Following this 8-week period the PPD as well as bleeding on probing (BOP), gingival recession (GR) and clinical attachment loss (CAL) were measured. The randomisation was carried out by a study-independent member of staff at the centre using a computer programme. CASE SELECTION: A total of 149 patients were assessed for eligibility for this trial. Out of these patients, 83 were deemed to be unsuitable for the trial as they failed to meet the inclusion criteria, and 24 declined to participate. A total of 42 patients were then randomised to each arm of the study. The inclusion criteria included patients with Stage III and IV periodontal disease. Patients were deemed eligible if they met the following criteria: presence of 18 or more scorable teeth (excluding 3rd molars); >4 teeth with PPD of >6 mm; CAL > 5 mm, and no previous periodontal treatment in the past. Percentage bone loss at the most severe site, smoking status, and presence of diabetes and diabetic control were all taken into consideration. Patients were deemed ineligible for the trial if they were pregnant or under 18 years old. Exclusion criteria also included: recent periodontal abscess; a past or current co-morbidity which may confound the results of the study or endanger patients partaking in the study (i.e. malignancy, rheumatoid arthritis, and other severe systemic conditions); and obesity. DATA ANALYSIS: PPD was used as the primary variable in this study. Other measured outcomes such as GR, CAL, BOP and other measurements taken, such as papillary bleeding index (PBI) and papillary inflamed surface area (PISA), were considered as secondary outcome variables. A variety of tests were used in order to assess the collected data. The Kolmogorov‒Smirnov test and Levene test were used for the equality of variances, and ICC and 95% CI were used when comparing periodontal chartings for PPD (in mm). Chi-square or Fisher tests were used for categorical data between intervention and placebo. The baseline and reevaluation data was compared using the McNemar test. All data was analysed using statistical software. Significant data is indicated by a p value < 0.05. RESULTS: The number of patients included for analysis was reduced to n = 20 for the intervention group and n = 19 for the placebo group. Patients were lost due to a variety of reasons including need for antibiotics and lost to follow-up. The authors concluded that in each arm of the trial, periodontal and hygiene parameters improved overall. The results show that the intervention group had a significantly higher reduction in PPD; however, following data analysis, these findings were found to be statistically insignificant. CONCLUSIONS: The authors conclude that the addition of a multi-nutrient supplement, alongside nsHPT for patients undergoing treatment for Stage III and IV periodontal disease, showed a reduction in PPD and BOP when compared with a placebo and nsHPT.

Thermosensitive and mucoadhesive gels containing solid lipid nanoparticles loaded with fluconazole and niosomes loaded with clindamycin for the treatment of periodontal diseases: a laboratory experiment.

BACKGROUND: Periodontal diseases may benefit more from topical treatments with nanoparticles rather than systemic treatments due to advantages such as higher stability and controlled release profile. This study investigated the preparation and characterization of thermosensitive gel formulations containing clindamycin-loaded niosomes and solid lipid nanoparticles (SLNs) loaded with fluconazole (FLZ), as well as their in vitro antibacterial and antifungal effects in the treatment of common microorganisms that cause periodontal diseases. METHODS: This study loaded niosomes and SLNs with clindamycin and FLZ, respectively, and assessed their loading efficiency, particle size, and zeta potential. The particles were characterized using a variety of methods such as differential scanning calorimetry (DSC), dynamic light scattering (DLS), and Transmission Electron Microscopy (TEM). Thermosensitive gels were formulated by combining these particles and their viscosity, gelation temperature, in-vitro release profile, as well as antibacterial and antifungal effects were evaluated. RESULTS: Both types of these nanoparticles were found to be spherical (TEM) with a mean particle size of 243.03 nm in niosomes and 171.97 nm in SLNs (DLS), and respective zeta potentials of -23.3 and -15. The loading rate was 98% in niosomes and 51% in SLNs. The release profiles of niosomal formulations were slower than those of the SLNs. Both formulations allowed the release of the drug by first-order kinetic. Additionally, the gel formulation presented a slower release of both drugs compared to niosomes and SLNs suspensions. CONCLUSION: Thermosensitive gels containing clindamycin-loaded niosomes and/or FLZ-SLNs were found to effectively fight the periodontitis-causing bacteria and fungi.

Insights into Intra Periodontal Pocket Pathogenesis, Treatment, In Vitro-In Vivo Models, Products and Patents, Challenges and Opportunity.

Periodontal disease is a multifactorial pathogenic condition involving microbial infection, inflammation, and various systemic complications. Here, a systematic and comprehensive review discussing key-points such as the pros and cons of conventional methods, new advancements, challenges, patents and products, and future prospects is presented. A systematic review process was adopted here by using the following keywords: periodontal diseases, pathogenesis, models, patents, challenges, recent developments, and 3-D printing scaffolds. Search engines used were "google scholar", "web of science", "scopus", and "pubmed", along with textbooks published over the last few decades. A thorough study of the published data rendered an accurate and deep understanding of periodontal diseases, the gap of research so far, and future opportunities. Formulation scientists and doctors need to be interconnected for a better understanding of the disease to prescribe a quality product. Moreover, prime challenges (such as a lack of a vital testing model, scarcity of clinical and preclinical data, products allowing for high drug access to deeper tissue regions for prolonged residence, lack of an international monitoring body, lack of 4D or time controlled scaffolds, and lack of successful AI based tools) exist that must be addressed for designing new quality products. Generally, several products have been commercialized to treat periodontal diseases with certain limitations. Various strategic approaches have been attempted to target certain delivery regions, maximize residence time, improve efficacy, and reduce toxicity. Conclusively, the current review summarizes valuable information for researchers and healthcare professional to treat a wide range of periodontal diseases.

Flavonoids effects against bacteria associated to periodontal disease and dental caries: a scoping review.

This scoping review focused on exploring the efficacy of flavonoids against bacteria associated with dental caries and periodontal diseases. Inclusion criteria comprise studies investigating the antibacterial effects of flavonoids against bacteria linked to caries or periodontal diseases, both pure or diluted in vehicle forms. The search, conducted in August 2023, in databases including PubMed/MEDLINE, Scopus, Web of Science, Embase, LILACS, and Gray Literature. Out of the initial 1125 studies, 79 met the inclusion criteria, majority in vitro studies. Prominent flavonoids tested included epigallocatechin-gallate, apigenin, quercetin, and myricetin. Predominant findings consistently pointed to bacteriostatic, bactericidal, and antibiofilm activities. The study primarily investigated bacteria associated with dental caries, followed by periodontopathogens. A higher number of publications presented positive antibacterial results against Streptococcus mutans in comparison to Porphyromonas gingivalis. These encouraging findings underline the potential applicability of commercially available flavonoids in materials or therapies, underscoring the need for further exploration in this field.

Assessment of the Smear Layer Removal Efficacy of Three Different Agents on Periodontally Compromised Tooth: An In Vitro Study.

AIM: The purpose of the present study was to evaluate the smear layer removal efficacy of three various agents on periodontally compromised tooth. MATERIALS AND METHODS: The current study included 75 molar teeth that were extracted due to periodontal disease. After that, 25 samples were randomly assigned using a simple random technique to the three different agent groups, group A: Scaling and root planing (SRP) and application of SofScale agent, group B: SRP and application of QMix agent, group C: SRP and application of MTAD agent. Using a diamond circular saw, the treated portions were divided into horizontal and vertical halves. All samples were viewed under Scanning Electron Microscope. Every tooth was focused at the coronal third, middle third, and apical third portion with a magnification of 1000×. Data were recorded and statistically analyzed. RESULTS: The smear layer removal efficacy was more in the QMix agent (3.06 ± 0.04) group followed by MTAD agent (3.28 ± 0.09) and SofScale agent (4.14 ± 0.10) group on the root surface. On intra group comparison, there was a statistically significant difference found in all the intra group agents with all the three levels. On inter group evaluation, at coronal third, there was no significant difference found between the different agents. There was a significant difference found between the different agents at middle and coronal third. CONCLUSION: On conclusion, the current investigation found that, the root surfaces treated with QMix shown a greater ability to remove smear layers compared to tooth surfaces treated with MTAD and SofScale agent. CLINICAL SIGNIFICANCE: Conventional therapies such as SRP effectively eliminate calculus, plaque, and necrosed cementum; nevertheless, they leave behind a smear layer that could impede normal healing. In an effort to overcome this, root conditioning agents were applied on the root surface to remove the smear layer. The traditional root conditioning agents such as citric acid have certain disadvantages, though, such as an acidic pH that could harm the root surface. As a result, researchers have been looking for biocompatible root conditioning treatments that are more effective. How to cite this article: Singh DK, BS Raj H, Soans CR, et al. Assessment of the Smear Layer Removal Efficacy of Three Different Agents on Periodontally Compromised Tooth: An In Vitro Study. J Contemp Dent Pract 2024;25(2):156-159.

Effect of sodium hypochlorite gel on bacteria associated with periodontal disease.

OBJECTIVES: An adjunct in non-surgical periodontal therapy might be sodium hypochlorite (NaOCl)-based agents. The purpose of the present in vitro study was to get deeper knowledge on the influence of different parameters as time after mixing, pH, and chemical composition of an amino acid 0.475% NaOCl (AA-NaOCl) gel consisting of two components on its anti-biofilm activity. MATERIALS AND METHODS: Six-species biofilms were cultured for 5 days, before AA-NaOCl gel was applied. In the different series, the influence of the time after mixing of the two components before application, of the concentration of NaOCl in the gel mixture, of the pH of the gel mixture, and of an exchange of the amino acid component by hyaluronic acid (HA), was analyzed. RESULTS: Mixing time point experiments showed that the AA-NaOCl gel is capable of statistically significantly reducing colony-forming unit (cfu) counts up to 30 min after mixing, but only up to 20 min after mixing the reduction was more than 2 log10 cfu. The pH experiments indicate that a reduced pH results in a reduced activity of the NaOCl formulation. NaOCl concentrations in the formulation in the range from 0.475 to 0.2% provide adequate activity on biofilms. A HA/NaOCl gel was equally active against the biofilm as the AA-NaOCl gel. CONCLUSION: Mixing of the components should be made in a timeframe of 20 min before applications. An optimization of the composition of the NaOCl formulation might be possible and should be a topic in further in vitro studies. CLINICAL RELEVANCE: The AA-NaOCl gel formulation can be mixed up to 20 min before application. Further, the study indicates that the composition of the NaOCl gel formulation can be optimized.

Efficacy of methylene blue-mediated antimicrobial photodynamic therapy on clinical and radiographic outcomes among patients with periodontal diseases: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: This study aimed to assess the influence of methylene blue (MB)-mediated adjunctive antimicrobial photodynamic therapy (aPDT) when compared to conventional mechanical debridement (MD) alone on periodontal clinical and radiographic outcomes among periodontitis patients. METHODS: Randomized clinical trials (RCTs) were incorporated by conducting an electronic search in Web of Science, Scopus, and PubMed for articles published in English up to August 2023 to address the following focused question based on the PICO format: "Whether the application of MB-mediated aPDT as an adjunctive to MD (Intervention) leads to improved periodontal clinical and/or radiographic outcomes (Outcome) among participants with and without periodontal diseases (Population) as compared to MD alone (Conparison)". The risk of bias (RoB) of the included studies was assessed using the modified Jadad scale. A meta-analysis was conducted, and it included the presentation of the standard mean difference (SMD) along with a 95 % confidence interval (CI). RESULTS: In total, 11 studies were included in this systematic review and meta-analysis. The meta-analysis demonstrated statistically significant improvements in periodontal plaque index (SMD: -0.72 % [95 % CI: -0.99 % to -0.45 %]; p<0.00001), probing depth (SMD: -0.38 % [95 % CI: -0.57 % to -0.19 %; p<0.00001), and bleeding on probing (SMD: -0.44 % [95 % CI: -0.68 % to -0.20 %]; p = 0.0003) scores at the final follow-up visit after the application of MB-mediated aPDT in comparison with MD alone. Nevertheless, there was no statistically significant difference was observed in periodontal clinical attachment level values (SMD: -0.01 % [95 % CI: -0.21 % to 0.19 %]; p = 0.95) between the control group and the experimental group. Six studies achieved a low RoB, five were rated as having medium RoB, while no study received a high RoB. CONCLUSION: MB-mediated aPDT, when used as an adjunct to conventional MD contributes to the improvement of periodontal clinical outcomes including PI, PD, and BOP in patients with periodontitis.

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.

Medicinal herbs, especially Hibiscus sabdariffa, inhibit oral pathogenic bacteria.

OBJECTIVES: Medicinal herbs are plants with potential medicinal and health benefits. In recent years, they are being increasingly used as a treatment alternative owing to their effectiveness against various diseases. In this study, we investigated the inhibitory effects of 15 medicinal herbs on causative bacteria for dental caries and periodontal disease. METHODS: This study evaluated the effects of the extracts of 15 medicinal herbs on growth and biofilm formation in five oral pathogenic bacterial strains. The herbs were processed into extracts, and bacterial strains were cultured. Then, bacterial growth and biofilm formation were assessed using various methods. Finally, the extract of the herb Hibiscus sabdariffa (hibiscus) was analyzed using high-performance liquid chromatography. RESULTS: Incubation of bacteria with the herbal extracts showed that hibiscus exerted a significant inhibitory effect on all the oral pathogenic bacterial strains evaluated in this study. In addition, the pigment delphinidin-3-sambubioside, which is found in hibiscus extract, was identified as a particularly important inhibitory component. CONCLUSIONS: These results lay the ground work for the potential development of novel therapeutic or preventive agents against dental caries and periodontal disease, two major oral diseases.

Occurrence of Luteolin in the Greek Flora, Isolation of Luteolin and Its Action for the Treatment of Periodontal Diseases.

Higher plants possess the ability to synthesize a great number of compounds with many different functions, known as secondary metabolites. Polyphenols, a class of flavonoids, are secondary metabolites that play a crucial role in plant adaptation to both biotic and abiotic environments, including UV radiation, high light intensity, low/high temperatures, and attacks from pathogens, among others. One of the compounds that has received great attention over the last few years is luteolin. The objective of the current paper is to review the extraction and detection methods of luteolin in plants of the Greek flora, as well as their luteolin content. Furthermore, plant species, crop management and environmental factors can affect luteolin content and/or its derivatives. Luteolin exhibits various biological activities, such as cytotoxic, anti-inflammatory, antioxidant and antibacterial ones. As a result, luteolin has been employed as a bioactive molecule in numerous applications within the food industry and the biomedical field. Among the different available options for managing periodontitis, dental care products containing herbal compounds have been in the spotlight owing to the beneficial pharmacological properties of the bioactive ingredients. In this context, luteolin's anti-inflammatory activity has been harnessed to combat periodontal disease and promote the restoration of damaged bone tissue.

Antimicrobial use practices in canine and feline dental procedures performed in primary care veterinary practices in the United States.

This study examined the utilization of antimicrobials in canines and felines receiving dental treatments in veterinary clinics in the United States, retrospectively. A total of 818,150 animals (713,901 procedures in dogs and 104,249 procedures in cats) underwent dental procedures under general anesthesia in 2020. These included dental prophylaxis and extractions. Patient demographic data, antimicrobial treatment, treatment duration, dose, periodontal disease score, whether tooth extractions were performed and how many extractions were performed was recorded. Our results showed that local or systemic antimicrobials were used in 116,723/713,901 (16.4%) procedures in dogs and 14,264/104,249 (14%) procedures in cats. Age, weight, extraction of one or more teeth and diagnosis of periodontal disease (any stage) were associated with increased likelihood of antimicrobial administration using univariable analysis (all P<0.001) and in the multivariable model. Clindamycin, amoxicillin-clavulanate and amoxicillin were the most common oral antimicrobials used in dogs and cats. Drugs classified as highest priority clinically important antibiotics (HPCIA) were administered to 30,960/116,723 (26.5%) of dogs and 7,469/14,264 (52%) of treated cats. The results obtained can inform interventions to optimize patient care and promote prudent use of antimicrobials during dental procedures in canine and feline patients.

COMPARATIVE STUDY OF BIOTOLERANCE CHARACTERISTICS OF DIFFERENT GELS COMPOSED OF BENZYDAMINE AND FLAVONOIDS THAT WERE DEVELOPED FOR TREATMENT OF PERIODONTAL DISEASES IN ORTHODONTIC PATIENTS.

OBJECTIVE: The aim: Different gels composed of benzydamine and flavonoids that were developed for treatment of periodontal diseases in the orthodontic patients will be compared regarding their effects on survival of mammalian cells of various tissue origin and their DNA intactness. PATIENTS AND METHODS: Materials and methods: Effect of different variants of patented gel composition «Benzidaflaziverdine¼ including a gel base and «Proteflazid®¼ containing flavonoids and benzydamine hydrochloride in powder form («T-Sept®¼) towards survival (MTT) of murine BALB-3T3 fibroblasts, J774.2 macrophages, human HaCaT keratinocytes was studied. Their effect on nativity of DNA of J774.2 macrophages was evaluated using DNA-comet assay. RESULTS: Results: Three gel compositions were used. Sample 1 was prepared on gel basis including benzydamine in liquid form and demonstrated inhibitory effect towards pseudonormal murine BALB-3T3 fibroblasts and murine J774.2 macrophages, however, normal human НаСаТ keratinocytes were resistant to its action. Sample 2 included BH in powder form and it did not affect significantly НаСаТ keratinocytes аnd BALB-3T3 fibroblasts, but it suppressed J774.2 macrophages. Sample 3 («Benzidaflaziverdine¼) was developed and patented by us as a gel composed of benzydamine in powder form and flavonoid drops «Proteflazid®¼. It did not suppress tested mammalian cells and was not genotoxic (measured as % of DNA in comet tail and Olive Tail Moment) for murine J774.2 macrophages. CONCLUSION: Conclusions: Inclusion of flavonoids in gel composition «Benzidaflaziverdine¼ blocked cytotoxic and genotoxic actions of benzydamine. Developed gel com¬position might be efficient in clinical periodontology, in particular, for treatment of periodontal diseases in orthodontic patients.