Periodontal Disease and novel therapeutic approaches

Periodontal disease, also known as gum disease, is a serious infection that affects the soft tissues of the supporting apparatus of the tooth. Most of the adult population can suffer from periodontitis, which can destroy the bone structure that supports the teeth if untreated, thus leading to loosening or even loss of teeth.

This is a common, yet preventable condition. It is the result of poor oral hygiene that leads to the formation of a complex bacterial biofilm that colonizes tooth surfaces that starts as gum inflammation and then extends to the periodontal ligament and alveolar bone. Symptoms include swollen, reddened, soft-touch gums that bleed easily, bad breath, and painful chewing. When these signs occur, it is advisable to visit the dentist as soon as possible. Clinically, the lesion can be seen as a “periodontal pocket“, which for simplicity can be described as a detachment of the gum tissue from the tooth meaning that the gum is resting on the tooth and no longer attached to it. The microenvironment of the pocket is ideal for the proliferation of aggressive bacteria capable of perpetuating the damage over time.

The measurement of the periodontal pocket through a probe, the detection of the bleeding index and, in some cases, the bacterial typing with DNA probes are the main diagnostic indicators for the severity of the pathology. In a healthy periodontium, there is no detachment of the gingival epithelium from the tooth and the space between the two is not less than 2 mm deep and the bleeding index is almost zero.

Available treatments include immediate non-surgical therapy, e.g., oral hygiene sessions with ultrasound and air-flow with glycine or erythritol to break down the supragingival bacterial biofilm and decontamination of periodontal pockets through root surface debridement (RSD) and scaling and root planing (SRP) to remove subgingival plaque and tartar. The goal is to mechanically remove the causative factor of periodontitis and thus promote natural healing of the gingiva and reduction of periodontal pockets. However, such maneuvers are sometimes limited by both the depth and anatomical complexity of the pocket and new bacterial colonization can infiltrate and re-infect the pockets after RSD and SRP, inhibiting the healing process.

Combination treatments with RSD and SRP have been developed to improve gingival healing and prevent recurrent infection and inflammation of periodontal pockets. Some of these methods include antimicrobial laser therapy through activation of a photosensitive molecule (photodynamic therapy), or the use of antibiotics or antimicrobial molecules delivered directly into periodontal pockets to reduce the bacterial load and prevent re-infection. Drug delivery is done through the use of paste mouthwashes or release scaffolds, which can be placed in the pockets with the permanence of days or weeks. Antibiotics, in addition to being used locally, can also be administered systemically, however, there is a risk of causing antibiotic resistance, which, in addition to being one of the major health risks for the world’s population, can worsen the patient’s clinical picture. We have explored in our previous articles how antimicrobial resistance is an emergent healthcare threat that may doom our lives if not properly tackled. Check them out (link).

Our strategy to avoid the use of antibiotics while improving the SRP gold standard treatment of periodontitis is Sterify gel. It is a mucoadhesive polymeric hydrogel in a pre-filled ready-to-use syringe. It can be applied inside the periodontal or peri-implant pocket after the SRP hygiene procedure. In the periodontal pocket, Sterify Gel acts primarily as a filler to restore volume by physically preventing bacteria from entering and re-infecting the pocket itself. The medical device can thus mechanically protect the treated pockets and bone defects, promoting tissue healing.  The occluding action at the level of periodontal and peri-implant gingival pockets, in synergy with the accessory action of hydroxytyrosol, nisin, and magnesium ascorbyl phosphate, creates an unsuitable environment for bacterial growth and promotes subsequent tissue regeneration. We have successfully ended the pre-clinical assessment, showing Sterify Gel biocompatibility, and started a clinical investigation according to Medical Device Regulation (EU) 2017/745.

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