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Advances in Periodontics and Restorative Dental Materials

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A special issue of Materials (ISSN 1996-1944). This special issue belongs to the section "Biomaterials".

Deadline for manuscript submissions: closed (20 March 2022) | Viewed by 39178

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Special Issue Editors

Prof. Carlo Bertoldi

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Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy
Interests: periodontal disease; periodontal regeneration; periodontitis pathogenesis; periodontitis treatment, dental implants; dental restoration; biomaterials; conservative; dental prosthesis; endoperiodontal-lesions; oral microbiota

Prof. Dr. Luigi Generali

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Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
Interests: endodontics; restorative dentistry; biomaterials; dental materials; endodontic instruments
Special Issues, Collections and Topics in MDPI journals

Dr. Stefania Bergamini

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Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, University of Modena and Reggio Emilia, Modena, Italy
Interests: proteomics; clinical pathology; gel electrophoresis, mass spectrometry; western blot technique; ELISA assay, chromatography; cell culture; biomaterials

Special Issue Information

Dear Colleagues,

The Special Issue on “Advances in Periodontics and Restorative Dental Materials” aims to bring together articles covering relevant scientific topics on periodontal disease diagnosis, pathogenesis, and advances in therapy. Moreover, the opportunity will be taken to discuss the state-of-the-art research on materials that could be used in restorative dentistry and endodontics with a positive influence on periodontal conditions. To this end, the methods, requested devices, and processing of materials could be high-tech and key to developing high-quality competitive products also going beyond these specific topics. This Special Issue will consider the foundation of technical progress in periodontology and dentistry, the development of novel diagnostic and therapeutic possibilities, and the production of novel materials in creating new designs for instruments and precision machinery as well as in developing technologies and systems.

This Special Issue is a timely approach to survey recent progress in the development and optimization of these subjects. The articles presented in this Special Issue will cover various topics ranging from advances in periodontal diagnosis, pathogenesis, therapy, endoperiodontal treatment, direct and indirect dental restoration, and studies on oral microbiota. Therefore, this Special Issue welcomes contributions from all researchers working in omics, biomolecular sciences, or materials processing in relation to periodontal health and dental restoration.

Prof. Carlo Bertoldi
Dr. Luigi Generali
Dr. Stefania Bergamini
Guest Editors

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Keywords

Periodontal disease
Periodontal pathogenesis
Periodontal diagnosis
Periodontal regeneration
Tooth preservation
Implant preservation
Dental restoration
Endoperiodontal lesions
Endodontics
Dental materials
Oral microbiota

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Published Papers (12 papers)

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11 pages, 2854 KiB

Open AccessArticle

Evaluation of Tensile Bond Strength between Self-Adhesive Resin Cement and Surface-Pretreated Zirconia

by Mijoo Kim, Reuben H. Kim, Samuel C. Lee, Thomas K. Lee, Marc Hayashi, Bo Yu and Deuk-Won Jo

Materials 2022, 15(9), 3089; https://doi.org/10.3390/ma15093089 - 24 Apr 2022

Cited by 8 | Viewed by 1890

Abstract

The tensile bond strength between zirconia subjected to different surface-pretreatment methods and methacryloyloxydecyl-dihydrogen-phosphate (MDP)-containing self-adhesive resin cement was evaluated herein. Eighty-eight cylindrical zirconia specimens were randomly divided into the following four groups based on the pretreatment method: (1) no treatment, (2) air abrasion, (3) HNO₃/HF etching, and (4) zirconia-nanoparticle coating. The tensile bond strength of the zirconia–resin-cement complexes was investigated. One-way ANOVA and post hoc tests were performed at a 95% significance level, and the Weibull modulus was calculated. Fracture patterns were visualized by SEM. The surface roughness of the specimens without resin bonding was evaluated by AFM. The tensile bond strength of the specimens decreased as follows: Groups 3 > 4 > 2 > 1 (28.2 ± 6.6, 26.1 ± 5.7, 16.6 ± 3.3, and 13.9 ± 3.0 MPa, respectively). Groups 3 and 4 had significantly higher tensile bond strengths (p < 0.05) and lower fracture probabilities than those of Groups 1 and 2. They also showed both mixed failure and resin-cement cohesive failure, whereas Groups 1 and 2 showed mixed failure exclusively. The zirconia–resin tensile bond was stronger after HNO₃/HF etching or ZrO₂-nanoparticle coating than after air abrasion or no treatment. The estimated surface roughness decreased as follows: Groups 3 > 4 > 2 > 1. The combination of zirconia pretreated with HNO₃/HF etching or ZrO₂-nanoparticle coating and an MDP-containing self-adhesive resin cement can increase the clinical longevity of zirconia restorations by preventing their decementation. Full article

(This article belongs to the Special Issue Advances in Periodontics and Restorative Dental Materials)

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14 pages, 708 KiB

Open AccessArticle

Proteomics Disclose the Potential of Gingival Crevicular Fluid (GCF) as a Source of Biomarkers for Severe Periodontitis

by Elisa Bellei, Carlo Bertoldi, Emanuela Monari and Stefania Bergamini

Materials 2022, 15(6), 2161; https://doi.org/10.3390/ma15062161 - 15 Mar 2022

Cited by 6 | Viewed by 2381

Abstract

Periodontal disease is a widespread disorder comprising gingivitis, a mild early gum inflammation, and periodontitis, a more severe multifactorial inflammatory disease that, if left untreated, can lead to the gradual destruction of the tooth-supporting apparatus. To date, effective etiopathogenetic models fully explaining the clinical features of periodontal disease are not available. Obviously, a better understanding of periodontal disease could facilitate its diagnosis and improve its treatment. The purpose of this study was to employ a proteomic approach to analyze the gingival crevicular fluid (GCF) of patients with severe periodontitis, in search of potential biomarkers. GCF samples, collected from both periodontally healthy sites (H-GCF) and the periodontal pocket (D-GCF), were subjected to a comparison analysis using sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). A total of 26 significantly different proteins, 14 up-regulated and 12 down-regulated in D-GCF vs. H-GCF, were identified by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The main expressed proteins were inflammatory molecules, immune responders, and host enzymes. Most of these proteins were functionally connected using the STRING analysis database. Once validated in a large scale-study, these proteins could represent a cluster of promising biomarkers capable of making a valuable contribution for a better assessment of periodontitis. Full article

(This article belongs to the Special Issue Advances in Periodontics and Restorative Dental Materials)

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9 pages, 5691 KiB

Open AccessArticle

Fracture Resistance in Non-Vital Teeth: Absence of Interproximal Ferrule and Influence of Preparation Depth in CAD/CAM Endocrown Overlays—An In Vitro Study

by Lucía Barallat, María Arregui, Sandra Fernandez-Villar, Blanca Paniagua and Andrés Pascual-La Rocca

Materials 2022, 15(2), 436; https://doi.org/10.3390/ma15020436 - 7 Jan 2022

Cited by 4 | Viewed by 2458

Abstract

There is ample evidence to support the use of endocrowns to restore endodontic teeth. However, the influence of the position of the interproximal margins on fracture strength has not yet been studied. The aim was to determine the relationship between the apicocoronal position of the interproximal restorative margins and fracture resistance in nonvital teeth restored with CAD/CAM endocrown overlays. Forty extracted human maxillary premolars were prepared for endocrown overlay restorations without ferrule on the interproximal aspects and classified according to the position of the interproximal restoration margins in relation to the alveolar crest: 2 mm (group A), 1 mm (group B), 0.5 mm (group C), and 0 mm (group D). Fracture strength was measured using a universal testing machine applying a compressive force to the longitudinal tooth axis. Group A had a mean fracture resistance of 859.61 (±267.951) N, group B 1053.9 (±333.985) N, group C 1124.6 (±291.172) N, and group D 780.67 (±183.269) N, with statistical differences between groups. Group C had the highest values for fracture strength compared to the other groups (p < 0.05). The location of the interproximal margins appears to influence the fracture resistance of CAD/CAM endocrown overlays. A distance of 0.5 mm between the interproximal margin and the alveolar crest was associated with increased fracture resistance. Full article

(This article belongs to the Special Issue Advances in Periodontics and Restorative Dental Materials)

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14 pages, 509 KiB

Open AccessArticle

The Expression of Allele Changes in NLRP3 (rs35829419) and IL-1β (+3954) Gene Polymorphisms in Periodontitis and Coronary Artery Disease

by Jaideep Mahendra, Abirami Nayaki Rao, Little Mahendra, Mohammed E. Sayed, Maryam H. Mugri, Thodur Madapusi Balaji, Saranya Varadarajan, Raghunathan Jagannathan, Sruthi Srinivasan, Hosam Ali Baeshen, Reji Mathew and Shankargouda Patil

Materials 2021, 14(17), 5103; https://doi.org/10.3390/ma14175103 - 6 Sep 2021

Cited by 6 | Viewed by 2270

Abstract

Background: Inflammasomes have been shown to play a pivotal role in periodontal disease pathogenesis. However, their role in periodontitis subjects with coronary heart disease remains unclear. This study aimed to obtain the expression of NLRP3 (rs35829419) and IL-1β (+3954) gene polymorphisms in the subgingival plaque and blood samples of generalized periodontitis (GP) subjects with and without coronary heart disease (CHD). Methods: A total of 70 subjects were grouped into two; GP and GP with CHD. Demographic variables and periodontal and cardiac parameters were recorded from both the groups. Subgingival plaque and blood samples were obtained from both the groups and were further subjected to the identification of NLRP3 (rs35829419) and IL-1β (+3954) expression and allele change using a conventional polymerase chain reaction (PCR) and gene sequencing (Sanger’s method). Results: Amongst the demographic variables, age and monthly income were statistically significant between the two groups. Plaque index (PI), clinical attachment level (CAL), high-density lipoprotein (HDL), and low density-lipoprotein (LDL) exhibited statistically significant levels between the two groups. The NLRP3 (rs35829419) and IL-1β (+3954) genes showed a statistically significant association with allele change (frequency) among the groups. The general comparison of all the parameters with the allele change of NLRP3 (rs35829419) and IL-1β (+3954) in the subgingival plaque and blood samples showed statistically significant associations among the two groups. Conclusion: The present study highlighted an allele change in IL-1β (+3954) gene polymorphisms which may play an important role in the pathogenesis of periodontitis and coronary heart disease. Full article

(This article belongs to the Special Issue Advances in Periodontics and Restorative Dental Materials)

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10 pages, 423 KiB

Open AccessArticle

miRNA-146a and miRNA-126 as Potential Biomarkers in Patients with Coronary Artery Disease and Generalized Periodontitis

by Jaideep Mahendra, Little Mahendra, Hytham N. Fageeh, Hammam Ibrahim Fageeh, Wael Ibraheem, Hesham H. Abdulkarim, Anilkumar Kanakamedala, Prashanthi Prakash, Sruthi Srinivasan, Thodur Madapusi Balaji, Saranya Varadarajan, Raghunathan Jagannathan and Shankargouda Patil

Materials 2021, 14(16), 4692; https://doi.org/10.3390/ma14164692 - 20 Aug 2021

Cited by 7 | Viewed by 2149

Abstract

The present study aims to compare the levels of micro-RNA-146a and micro-RNA-126 in oral subgingival plaque and coronary plaque from artery walls in patients with coronary artery disease who suffer from generalized periodontitis. A total of 75 participants were selected and grouped into three categories of 25 patients each: GP+CAD, GP, and HP groups. GP+CAD consisted of patients diagnosed with generalized periodontitis (GP) and coronary artery disease (CAD). The GP+CAD group was further divided into two groups—GP+CADa: where subgingival plaque samples were collected; GP+CADb group: where coronary plaque samples were collected while the patient underwent a coronary artery bypass grafting surgery. The GP group consisted of 25 patients diagnosed with only generalized periodontitis. The HP group consisted of 25 systemically and periodontally healthy controls. miRNA-146a and miRNA126 levels were assessed in subgingival plaque (SP) samples from all groups. Results revealed that miRNA-146a was expressed at higher levels and miRNA-126 was downregulated in the GP+CAD group. microRNAs in subgingival plaque samples showed a significant correlation with the coronary plaque samples in the GP+CAD group. miRNA-146a and miRNA-126 were present in coronary artery disease patients with periodontitis. These micro-RNAs may serve as risk biomarkers for coronary artery disease and generalized periodontitis. Full article

(This article belongs to the Special Issue Advances in Periodontics and Restorative Dental Materials)

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11 pages, 805 KiB

Open AccessArticle

A Proteomic Analysis of Discolored Tooth Surfaces after the Use of 0.12% Chlorhexidine (CHX) Mouthwash and CHX Provided with an Anti-Discoloration System (ADS)

by Stefania Bergamini, Elisa Bellei, Luigi Generali, Aldo Tomasi and Carlo Bertoldi

Materials 2021, 14(15), 4338; https://doi.org/10.3390/ma14154338 - 3 Aug 2021

Cited by 5 | Viewed by 2549

Abstract

Chlorhexidine (CHX) is considered the gold standard for the chemical control of bacterial plaque and is often used after surgical treatment. However, CHX employment over an extended time is responsible for side effects such as the appearance of pigmentations on the teeth and tongue; the discoloration effects are less pronounced when using a CHX-based mouthwash with added an anti-discoloration system (ADS). The aim of this study was to evaluate, using one- and two-dimensional gel electrophoresis combined with mass spectrometry, the possible proteomic changes induced by CHX and CHX+ADS in the supragingival dental sites susceptible to a discoloration effect. The tooth surface collected material (TSCM) was obtained by curettage after resective bone surgery from three groups of patients following a supportive therapy protocol in which a mechanical control was combined with placebo rinses or CHX or a CHX+ADS mouthwash. The proteomic analysis was performed before surgery (basal conditions) and four weeks after surgery when CHX was used (or not) as chemical plaque control. Changes in the TSCM proteome were only revealed following CHX treatment: glycolytic enzymes, molecular chaperones and elongation factors were identified as more expressed. These changes were not detected after CHX+ADS treatment. An ADS could directly limit TSCM forming and also the CHX antiseptic effect reduces its ability to alter bacterial cell permeability. However, Maillard’s reaction produces high molecular weight molecules that change the surface properties and could facilitate bacterial adhesion. Full article

(This article belongs to the Special Issue Advances in Periodontics and Restorative Dental Materials)

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13 pages, 665 KiB

Open AccessArticle

Influence of Tooth-Brushing on Early Healing after Access Flap Surgery: A Randomized Controlled Preliminary Study

by Carlo Bertoldi, Luigi Generali, Pierpaolo Cortellini, Michele Lalla, Sofia Luppi, Aldo Tomasi, Davide Zaffe, Roberta Salvatori and Stefania Bergamini

Materials 2021, 14(11), 2933; https://doi.org/10.3390/ma14112933 - 29 May 2021

Cited by 3 | Viewed by 2656

Abstract

In the present study, the clinical outcomes obtained using three different protocols of post-operative plaque control for the 4 weeks after surgery were compared. Thirty healthy subjects, presenting at least one periodontal pocket requiring resective surgery, were selected and randomly distributed to three different groups corresponding to respective post-surgical protocols: (A) toothbrushes + chlorhexidine + anti-discoloration system (ADS + CHX); (B) toothbrushes + chlorhexidine (CHX); (C) only toothbrushes. The full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing pocket depth (PPD), recession depth (REC), clinical attachment level (CAL), and bleeding on probing (BoP) were measured in six aspects per tooth (mesio-buccal (MB), buccal (B), disto-buccal (DB), disto-lingual (DL), lingual (L), and mesio-lingual (ML)) at baseline, 3 months, and 6 months after surgery. FMPS and FMBS did not significantly change (p > 0.05), whereas PPD and CAL significantly decreased, and REC significantly increased in all groups during the study (p < 0.05). Clinical results were satisfactory in all cases, with no significant differences between groups 3 months after surgery. Six months after surgery, only PPD-MB was significantly different in the three groups (p < 0.05). Nevertheless, this value was not clinically relevant because the value of PPD-B (about 2 mm) in group C was physiologic. The mechanical plaque control was proven to be fundamental and sufficient in all the six aspects per tooth to guarantee an excellent clinical outcome without the need of chemical plaque control. Full article

(This article belongs to the Special Issue Advances in Periodontics and Restorative Dental Materials)

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14 pages, 1479 KiB

Open AccessArticle

Evaluation of Cytotoxicity and Antibacterial Activity of a New Class of Silver Citrate-Based Compounds as Endodontic Irrigants

by Luigi Generali, Carlo Bertoldi, Alessandro Bidossi, Clara Cassinelli, Marco Morra, Massimo Del Fabbro, Paolo Savadori, Nidambur Vasudev Ballal and Luciano Giardino

Materials 2020, 13(21), 5019; https://doi.org/10.3390/ma13215019 - 6 Nov 2020

Cited by 20 | Viewed by 3340

Abstract

In the present study, the cytotoxicity and the antimicrobial activity of two silver citrate-based irrigant solutions were investigated. Cytotoxicity of various concentrations (0.25%, 0.5%, 1%, 2.5%, 5%) of both solutions (BioAKT and BioAKT Endo) was assessed on L-929 mouse fibroblasts using the MTT assay. For the quantitative analysis of components, an infrared (I.R.) spectroscopy was performed. The minimum inhibitory and minimal bactericidal concentrations (M.I.C. and M.B.C., respectively) were ascertained on Enterococcus faecalis strain ATCC 4083. For biofilm susceptibility after treatment with the irrigating agent, a minimum biofilm eradication concentration (M.B.E.C.) and confocal laser scanning microscope (C.L.S.M.) assays were performed. Quantification of E. faecalis cell biomass and percentage of live and dead cells in the biomass was appraised. Normality of data was analyzed using the D’Agostino & Pearson’s test and the Shapiro–Wilk test. Statistical analysis was performed using one-way analysis of variance (ANOVA) and Tukey’s test. Both silver citrate solutions showed mouse fibroblasts viability >70% when diluted to 0.25% and 0.5%. Conversely, at higher concentrations, they were extremely cytotoxic. F.T.-IR spectroscopy measurements of both liquids showed the same spectra, indicating similar chemical characteristics. No substantial contrast in antimicrobial activity was observed among the two silver citrate solutions by using broth microdilution methods, biofilm susceptibility (MBEC-HTP device), and biomass screening using confocal laser scanning microscopy (C.L.S.M.) technique. Both solutions, used as root canal irrigants, exhibited significant antimicrobial activity and low cytocompatibility at dilutions greater than 0.5%. Full article

(This article belongs to the Special Issue Advances in Periodontics and Restorative Dental Materials)

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28 pages, 1721 KiB

Open AccessReview

Bioactive Glasses in Periodontal Regeneration: Existing Strategies and Future Prospects—A Literature Review

by Valeria Cannillo, Roberta Salvatori, Stefania Bergamini, Devis Bellucci and Carlo Bertoldi

Materials 2022, 15(6), 2194; https://doi.org/10.3390/ma15062194 - 16 Mar 2022

Cited by 15 | Viewed by 3553

Abstract

The present review deals with bioactive glasses (BGs), a class of biomaterials renowned for their osteoinductive and osteoconductive capabilities, and thus widely used in tissue engineering, i.e., for the repair and replacement of damaged or missing bone. In particular, the paper deals with applications in periodontal regeneration, with a special focus on in vitro, in vivo and clinical studies. The study reviewed eligible publications, identified on the basis of inclusion/exclusion criteria, over a ranged time of fifteen years (from 1 January 2006 to 31 March 2021). While there are many papers dealing with in vitro tests, only a few have reported in vivo (in animal) research, or even clinical trials. Regardless, BGs seem to be an adequate choice as grafts in periodontal regeneration. Full article

(This article belongs to the Special Issue Advances in Periodontics and Restorative Dental Materials)

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15 pages, 589 KiB

Open AccessReview

Complete Obturation—Cold Lateral Condensation vs. Thermoplastic Techniques: A Systematic Review of Micro-CT Studies

by Shilpa Bhandi, Mohammed Mashyakhy, Abdulaziz S. Abumelha, Mazen F. Alkahtany, Mohamed Jamal, Hitesh Chohan, A. Thirumal Raj, Luca Testarelli, Rodolfo Reda and Shankargouda Patil

Materials 2021, 14(14), 4013; https://doi.org/10.3390/ma14144013 - 18 Jul 2021

Cited by 43 | Viewed by 7123

Abstract

To prevent re-infection and provide a hermetic seal of the root canal system, an endodontist must aim to produce a void-free obturation. This review aimed to compare the completeness of root canal obturation between the two most prevalent methods—cold lateral condensation and warm gutta-percha techniques—using micro-CT (PROSPERO reg no. 249815). Materials and Methods: A search of Scopus, Embase, PubMed (Medline via PubMed), and Web of Science databases was done without any time restriction according to the PRISMA protocol. Articles that compared both techniques and were published in English were included. Data was extracted and the risk of bias was assessed using an adapted tool based on previous studies. Results: A total of 141 studies were identified by the search. Following the screening and selection of articles, 9 studies were included for review. Data was extracted manually and tabulated. Most studies had a moderate risk of bias. None determined operator skill in both methods before comparison. The data extracted from the included studies suggests that both techniques produce voids in the obturation. The thermoplasticized gutta-percha techniques may result in fewer voids compared to cold lateral condensation. Conclusion: Considering the limitations of the included studies, it was concluded that neither technique could completely obturate the root canal. Thermoplasticized gutta-percha techniques showed better outcomes despite a possible learning bias in favor of cold lateral condensation. Establishing operator skills before comparison may help reduce this bias. Full article

(This article belongs to the Special Issue Advances in Periodontics and Restorative Dental Materials)

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39 pages, 2431 KiB

Open AccessReview

Polymer-Based Carriers in Dental Local Healing—Review and Future Challenges

by Dorota Kida, Aneta Zakrzewska, Jacek Zborowski, Małgorzata Szulc and Bożena Karolewicz

Materials 2021, 14(14), 3948; https://doi.org/10.3390/ma14143948 - 14 Jul 2021

Cited by 10 | Viewed by 3186

Abstract

Polymers in drug formulation technology and the engineering of biomaterials for the treatment of oral diseases constitute a group of excipients that often possess additional properties in addition to their primary function, i.e., biological activity, sensitivity to stimuli, mucoadhesive properties, improved penetration of the active pharmaceutical ingredient (API) across biological barriers, and effects on wound healing or gingival and bone tissue regeneration. Through the use of multifunctional polymers, it has become possible to design carriers and materials tailored to the specific conditions and site of application, to deliver the active substance directly to the affected tissue, including intra-periodontal pocket delivery, and to release the active substance in a timed manner, allowing for the improvement of the form of application and further development of therapeutic strategies. The scope of this review is polymeric drug carriers and materials developed from selected multifunctional groups of natural, semi-synthetic, and synthetic polymers for topical therapeutic applications. Moreover, the characteristics of the topical application and the needs for the properties of carriers for topical administration of an active substance in the treatment of oral diseases are presented to more understand the difficulties associated with the design of optimal active substance carriers and materials for the treatment of lesions located in the oral cavity. Full article

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Other

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27 pages, 873 KiB

Open AccessSystematic Review

Melatonin as a Topical/Systemic Formulation for the Management of Periodontitis: A Systematic Review

by Thodur Madapusi Balaji, Saranya Varadarajan, Raghunathan Jagannathan, Jaideep Mahendra, Hammam Ibrahim Fageeh, Hytham N. Fageeh, Shazia Mushtaq, Hosam Ali Baeshen, Shilpa Bhandi, Archana A. Gupta, A. Thirumal Raj, Rodolfo Reda, Shankaragouda Patil and Luca Testarelli

Materials 2021, 14(9), 2417; https://doi.org/10.3390/ma14092417 - 6 May 2021

Cited by 32 | Viewed by 4164

Abstract

Objectives: To qualitatively and quantitatively review the use of melatonin as a topical/systemic formulation for the management of periodontitis. Materials and methods: PubMed; Scopus; and Web of Science databases were searched using the MesH terms “melatonin” and “periodontitis”. Title and abstracts were screened to eliminate irrelevant and duplicate articles. The full text data of the screened articles were assessed using the selection criteria. Results: Of 176 identified articles (PubMed-66; Scopus-56; Web of Science-52; Cross-reference-2), only 12 studies qualified to be included in the systematic review. Four studies assessed the independent effect of 1% topical melatonin formulation while 8 articles assessed the adjunctive use of systemic melatonin formulation (1–10 mg) following scaling and root planing (SRP). All studies showed an improvement in periodontal parameters such as pocket depth, clinical attachment loss, periodontal disease index, community periodontal index, gingival bleeding scores, and prognostic marker levels in saliva and serum. A meta-analysis of data from 2 studies revealed that 1–2 mg (systemic) melatonin supplementation reduced pocket depth; although the difference was not statistically significant and hence cannot be interpreted or used for conclusive evidence. Risk of Bias Assessment tool (RoBANS) and Cochrane Collaboration RoB tool elicited a high risk of bias in the included studies. GRADE (recommendation assessment, development, and evaluation) inferred a weak recommendation for the use of melatonin in periodontitis management. Conclusions: Melatonin supplementation (topical and systemic) in periodontitis patients improved key periodontal parameters including pocket depth and clinical attachment loss. Clinical relevance: Melatonin could be a potential host modulatory agent for periodontitis management; although the data from the present review should be interpreted carefully due to the associated high risk of bias. Full article

(This article belongs to the Special Issue Advances in Periodontics and Restorative Dental Materials)

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