Department of Pharmaceutical Science, Loknete Dr. J. D. Pawar College of Pharmacy, Manur, Tal. Kalwan.
Periodontal diseases are among the most prevalent bacterial infections, affecting 35% of the adult population worldwide. These diseases come in two main forms: gingivitis and periodontitis. Periodontitis is a potential risk factor for other health conditions, including heart disease. Gingivitis is a widespread inflammation of the gums that begins with plaque buildup below the gum line, leading to significant harm to the gums and bones. Periodontist is, in contrast, is an inflammatory disease characterized by bacterial proliferation within the gum pockets. This accumulation of bacteria can ultimately result in the loosening of teeth. There are two main types of periodontitis: aggressive, which can be localized or widespread. Controlled-release antimicrobial agents can provide added benefits for targeted periodontal damage when used alongside traditional mechanical cleaning methods. On the other hand, systemic drug delivery, which achieves therapeutic levels at the infection site, but for brief periods, necessitates frequent dosing over longer durations. Biodegradable polymers are frequently employed in dental drug delivery systems, offering advantages such as biocompatibility, non-toxicity, and ease of accessibility. This review examines the primary strategies for administering drugs to periodontal pockets, evaluates their effectiveness, and addresses the ongoing innovations in these techniques for periodontal treatment. The World Health Organization states that between 10% and 15% of the world's population experiences severe periodontitis. This condition arises due to the proliferation of various microorganisms, particularly anaerobes, within the gum pockets, the release of harmful substances, and enzymes, and the activation of the body's immune system.
Periodontal diseases are among the most common bacterial infections, affecting 35% of adults worldwide. These conditions primarily manifest in two forms: periodontitis and gingivitis. Gingivitis is a prevalent and reversible ailment marked by mild inflammation of the gums, accompanied by swelling and bleeding during oral care. It affects nearly half of adults and can progress to periodontitis, a more severe disease if poor oral habits persist and plaque accumulates. Periodontitis involves the general inflammation of the tissues around the teeth, starting with the buildup of plaque under the gums and leading to significant damage to the soft tissues and bone. If not addressed, it may lead to the deterioration of the tooth's supporting structures, such as the alveolar bone and periodontal ligament. [1] These conditions advance in cyclical stages of flare-ups, recovery, and dormancy, which are closely linked to the effectiveness of the body's immune response. Advances in scientific knowledge have enabled experts to distinguish between various forms of progressions, including generalized, localized, aggressive, and those associated with endodontic lesions or necrotizing ulcers. Additionally, factors such as subgingival plaque, smoking, and certain immune disorders like diabetes mellitus or AIDS can exacerbate chronic periodontitis. [6] Over 700 distinct bacterial species have been identified in the plaque located beneath the gums. The bacteria responsible for dental caries include Streptococcus mutans, whereas those linked to gingivitis encompass Prevotella intermedia, Campylobacter rectus, Treponema denticola, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Fusobacterium nucleatum, among others. In the early stage of gingivitis, the inflammation is limited to the gum tissue. However, it can progress to periodontitis, where the inflammation extends to deeper tissues, resulting in symptoms such as swelling, bleeding, and halitosis. As the condition progresses, the supportive tissues of the periodontium experience deterioration, resulting in the loss of alveolar bone and the movement of the gingival epithelium along the surface of the tooth, ultimately forming a 'periodontal pocket.' This pocket provides an optimal environment for the growth of bacteria, particularly Gram-negative, facultative anaerobic species such as Bacteroides intermedius and B. gingivalis. It also supports the presence of fusiform organisms, including Actinobacillus actinomycetemcomitans, Wolinella recta, and Eikenella spp., in addition to a diverse array of other microorganisms, including cocci, spirochetes, amoebas, and trichomonads. [2].
Figure 1: A flowchart depicting the progression of periodontal diseases, including the formation of bacterial biofilm, the mineralization process of the biofilm, and the subsequent pathological and immune responses that result in gingivitis and periodontitis.
The periodontal pocket remains, and if it continues to harbor bacteria associated with the disease, there is a risk of further advancement of the condition. This may require extensive treatment, and without it, the teeth could be lost. Eliminating the infection located under the gums and treating the periodontal pocket are critical goals in the treatment of periodontitis. Figure 1 illustrates the various mechanisms that may lead to the onset of periodontal diseases, while Figure 2 outlines the distinct stages of periodontitis. [8]
Figure 2: Illustrated progression from healthy gingivae to periodontitis: (1) Normal gingiva, (2) Bacterial plaque formation, (3) Gingivitis develops due to bacterial toxins and host response, and (4) Advanced disease leads to periodontitis, characterized by destruction of gingiva and supporting bone.
There Are Two Distinct Categories of Local Medication Delivery Systems:
1.The goal of these drug delivery systems is to deliver medication directly to the source of the problem, the periodontal pocket.; however, they lack a method for maintaining therapeutic concentrations over a prolonged duration. The medication concentration at the location typically shows exponential increases and decreases using such a device.
2. Targeted delivery systems release medication slowly, providing long-lasting antibacterial effects exactly where they're needed. [6]
Advantages Of Local Medication Delivery Systems: -
Disadvantages Of Local Medication Delivery Systems: -
2.The Concept of a Local Intrapocket Delivery System for Antibacterial Medications:
1. The periodontal pocket serves as a natural reservoir that interacts with gingival crevicular fluid, facilitating easy placement of a delivery device.
2. Gingival crevicular fluid acts as a medium for the gradual release and distribution of medication from its solid dosage form within the periodontal pocket.
3. The characteristics of periodontal diseases, particularly their localized occurrence around the pocket, make the periodontal pocket an ideal location for treatment using local sustained-release delivery systems.
The primary objective of utilizing an intrapocket device for delivering an antibacterial agent is to establish and maintain therapeutic drug concentrations for the necessary period. [9]
Figure 3. A visual illustration depicting the use of different intra-pocket delivery devices. Fiber is positioned beneath the tooth gum; The gel is applied to the periodontal pocket, allowing for the release of microparticles and nanoparticles below the gum line, while a film is positioned beneath the gum of the tooth. [21]
3.Medication Delivery Solutions for Periodontal Health Management:
Multiple drug delivery methods exist for the management of periodontitis, such as fibbers, films, injectable systems, gels, strips, compacts, and vesicular systems.
Introduction:
Fibers, resembling thread-like structures, serve as reservoir systems that are circumferentially placed into periodontal pockets with the aid of an applicator and fixed in position using cyanoacrylate adhesive, enabling the prolonged release of the encapsulated medication.
The tetracycline release from cellulose acetate Fibers takes place swiftly via a diffusion process, with around 95% of the drug being released in the initial two hours. As a result, a single application of these Fibers fails to sustain an effective drug concentration for prolonged durations. [25] Unlike the less effective delivery of tetracycline from hollow Fibers, Fibers infused with 20% (v/v) chlorhexidine, when inserted into periodontal pockets, showed a marked and immediate decrease in the signs and symptoms of periodontal disease. While hollow Fibers serve as competent drug carriers, they facilitate a rapid release of the medication. [22] Monolithic Fibers designed to reduce drug release were developed by integrating the drug into molten polymers, which were then spun at elevated temperatures and allowed to cool. A range of polymers, such as poly(e-caprolactone) (PCL), polyurethane, polypropylene, cellulose acetate propionate, and ethyl vinyl acetate (EVA), have been investigated as potential matrices for delivering drugs to the periodontal pocket. Monolithic EVA Fibers have demonstrated their efficacy in controlling the release of encapsulated drugs, as evidenced by numerous Bioadhesive and in vivo investigations. Research conducted by Tonetti et al. revealed that EVA fibers infused with 25% tetracycline hydrochloride sustained a stable drug concentration in the gingival crevicular fluid (GCF) exceeding 600 mg/ml for a duration of ten days, showcasing zero-order release kinetics. [18]
This system has undergone extensive evaluations of drug delivery kinetics from EVA fibers and has participated in multiple clinical trials to determine its effectiveness in treating periodontal diseases. One particular study, which included 121 sites from 20 patients, focused on assessing the safety and efficacy of tetracycline-loaded EVA fibers used after scaling procedures. [7]
Figure 4. Fibers and their placement.
The integration of tetracycline fiber therapy with scaling and root planing (SRP) led to a significant decrease in the recurrence rate of periodontal disease, which was recorded at 4%. This is in contrast to the recurrence rates observed with SRP alone at 9%, tetracycline fiber treatment for 10 days at 10%, and for 20 days at 12%. Many meticulously designed and controlled studies have shown the clinical effectiveness of these fibers; however, the intricate nature of the fiber placement technique has hindered clinicians from fully evaluating their benefits in patient care. [7] According to a study, patients felt uncomfortable while the fiber was being placed, and different levels of gingival redness were visible when the fiber was being removed. The acceptance of this device by both patients and periodontists may be limited due to challenges associated with positioning the fiber, the necessity of maintaining it within the pocket, and the need to remove the device after a period of seven to ten days. (22)
The initial category of fibers was non-biodegradable, leading to discomfort due to the necessity of a secondary procedure for their removal, which was also linked to gum redness during the healing process. To address this issue, biodegradable fibers, such as collagen fibers, were introduced to the market. Notably, a novel technique for producing polymeric nanofibers with enhanced biochemical properties has emerged, known as electrospinning (see Figure 5). This approach enables the development of fibrous structures that replicate the natural extracellular matrix and can be tailored to include inorganic materials, bioactive substances, or pharmaceutical agents. Polylactic-co-glycolic acid (PLGA) and gelatin (GEL) are materials well-suited for electrospinning, as they exhibit excellent biocompatibility and biodegradability
Figure 5. The process of electrospinning is utilized to produce nanofibers, each exhibiting antibacterial and anti-inflammatory properties while also facilitating tissue regeneration. These nanofibers are organized into membranes, which are subsequently applied to areas affected by periodontitis.
Fibers In Drug Delivery Systems For Treating Periodontitis Have Several Key Characteristics That Enhance Their Effectiveness. Here Are Some Important Features:
Porosity: A porous structure can facilitate the absorption of fluids and improve drug diffusion, ensuring better penetration into periodontal tissues.
Introduction-
In thin matrix bands known as strips and films (SFs), medications are uniformly distributed within the polymer. These SFs are positioned within the interproximal periodontal pocket area and are particularly effective in adapting to the size and shape of the periodontal pocket. As a result, patients experience little discomfort during the procedure. Acrylics loaded with various antibiotics were the first materials suggested for use in the creation of strips and films. The materials exhibited a significant drug release on the initial day after insertion, which was then followed by a prolonged release period lasting 4 to 5 days. [10] The persistence of these materials in the environment poses a considerable challenge, requiring an additional removal process. This process is complicated by the fact that they tend to soften in cerebrospinal fluid, leading to gum irritation. To overcome this issue, innovative bioabsorbable materials have been developed, including poly-hydroxybutyric acid, polylactic-co-glycolic acid (PLGA), atelocollagen, gelatin, and chitosan/PLGA, among others. Testing of these new materials has shown promising outcomes. Non-biodegradable SFs released the therapeutic agent via the process of diffusion. In the meantime, erosion and diffusion release biodegradable SF. Research has shown that SFs containing antibiotics and antiseptics can effectively maintain concentration over the long term and improve gingivalhealth clinically. When Friesen et al. evaluated SRP's superiority in relation to strips loaded with tetracyclines as opposed to SRP alone and showed that multiple strips are significantly more effective at lowering probing depths than a single strip. [11] Previous research has indicated that chlorhexidine-loaded strips may be less effective in periodontal therapy compared to alternative agents. However, Paolantonio et al. demonstrated that areas treated with chlorhexidine chips experienced a significantly greater decrease in probing depths (p < 0>[15] Herbal-derived agents have been incorporated alongside research on antibiotics and chlorhexidine to address a major limitation of antibacterial medications, specifically antibiotic resistance. As an instance, Kudva et al. investigated how green tea affected periodontal health and showed how its bactericidal properties improved the clinical appearance of gums. [12]
Figure 6. Strips and Films and their placement.
Ultimately, SFs share the same variety of materials as fibres for their production. They vary in their release rates, which are affected by their size and intended use. The size of the SFs contributes to a slower release rate in comparison to fibers, especially in less accessible and remote locations. In contrast, due to their wider size, SFs are more suitable for larger pockets and spaces. The market is currently introducing smaller LDDSs, including nanoparticles, microspheres, and gels, which are gaining popularity and starting to outpace the use of both fibers and SFs. [13]
Strips And Films in Drug Delivery Systems For Treating Periodontitis Have Several Important Characteristics That Enhance Their Therapeutic Effectiveness. Here Are The Key Features:
C. Microparticles:
Introduction:
Drugs are loaded into solid spherical polymer structures called microparticles, which have a diameter ranging from 1 to 1000 µm and disperse evenly throughout the polymer matrix. Although they are incredibly simple to use and offer a long-lasting drug release, they are not quickly retained in the intended location. They are injected directly into the pocket, via dental pastes/gel systems, or via chips, among other carrier systems (Figure 7).
Microparticles can originate from natural sources, altered natural materials, and synthetic polymers, and they are categorized as either biodegradable or non-biodegradable. Esposito and colleagues performed in vitro experiments using three varieties of microparticles that were loaded with tetracyclines: poly(L-lactide) [L-PLA], poly(DL-lactide) [DL-PLA], and poly(DL-lactide-co-glycolide) in a 50:50 ratio [DL-PLG]. The release kinetics were influenced by the composition of the microparticles, with all formulations showing promise for clinical applications by delivering tetracyclines in a regulated manner over a two-week period. [14] Tetracycline-loaded lactic-co-glycolic acid (PLGA) microparticles are commonly utilized; however, they encounter issues like low loading efficiency for drugs that are highly soluble in water and slow degradation rates. This results in an extended duration of empty microspheres remaining in periodontal pockets following the loading of minocycline.[26] Wu and associates investigated an intrapocket delivery mechanism for minocycline to complement scaling and root planing. This approach involved the ion-pairing and complexation of minocycline with calcium ions and biopolymers containing sulfate or sulfonate groups. Their in vitro study revealed a high loading efficacy of 96.98% ± 0.12% and a loading content of 44.69% ± 0.03% for minocycline, significantly exceeding the typical loading content of 10%. The antimicrobial properties targeting Aggregatibacter actinomycetemcomitans and Streptococcus mutans were evaluated through agar disk diffusion and biofilm assays, fostering significant optimism regarding the clinical use of micromaterials developed via ion pairing and complexation. [20]
Figure 7. Microparticles and nanosystems and their placement.
Pichayakorn et al. conducted a study on cross-linked chitosan microparticles that included metronidazole (MTZ) in their quest to develop an ideal microparticle formulation. The results of this in vitro study demonstrated that the MTZ microparticles, defined by specific parameters, were the most effective formulation among those tested. [17] These parameters included 1 percent Span80 in soybean oil, 5 percent glutaraldehyde in the chitosan solution, a cross-linking time of 30 minutes, a drug-to-chitosan ratio of 1:1, the use of the drug in an ethanol solution, and washing solely with hexane. The MTZ microparticles showed a sustained release profile and an entrapment efficiency of 59.40 percent. Furthermore, the study assessed the drug release from MTZ microparticles within hydrogels and films, comparing it to the release from drug powders.
Microparticles Designed for Periodontitis Treatment Possess Certain Key Attributes That Significantly Enhance Their Therapeutic Efficacy:
d. Gels:
Introduction:
Various polymers can be utilized in their production, such as chitosan, carbopol, and carboxymethyl cellulose. Chitosan is a widely used material in dentistry, particularly for the treatment of periodontal disease. Previous formulations of local drug delivery systems have been referenced. The biological characteristics of this substance, which encompass antibacterial, anti-inflammatory, and wound-healing properties, render it appropriate for application. The application of this gel has demonstrated positive clinical results and efficacy in combating periodontal pathogens, including Porphyromonas gingivalis. A modern innovation in gel formulation is the creation of in situ formed gels, which change from a liquid to a semisolid state when exposed to stimuli such as temperature changes or interactions with solvents. Gels have been linked to a significant drawback despite being effective delivery systems: a comparatively quick release of the drug that has been captured. To address this issue, scientists have created gel and other drug delivery system combinations. Wang and associates created a versatile injectable local delivery system by integrating poly(lactic-co-glycolic acid) (PLGA) drug microspheres within a thermo-reversible polyisocyanopeptide (PIC) hydrogel. This system underwent assessment via both in vitro and in vivo studies utilizing rat models. Deep and irregular pockets can be more easily penetrated by new thermo-reversible PIC hydrogels, which will gel in situ as soon as they reach body temperature. [19] Mou and his team have created serum albumin microspheres that embed minocycline and zinc oxide nanoparticles (ZNO NPs) within a Carbopol 940® hydrogel. This study yielded impressive findings, showcasing an outstanding encapsulation efficiency of 99.99% for minocycline and an extended-release duration surpassing 72 hours, along with pH-sensitive characteristics. An extra in vitro evaluation was conducted to assess the safety of this formulation on cellular structures. The cell survival rates were greater than 85% at concentrations below 0.8 mg/L of ZnO nanoparticles, indicating low toxicity and a significant degree of safety. This finding supports the potential for clinical trials as a supplementary treatment for periodontal therapy. Additionally, we've talked about the different formulations that are primarily antibiotic-loaded, but as we've previously mentioned, it can be difficult to replace antibiotics with therapeutic agents that have comparable effects without developing bacterial resistance. Anti-inflammatory medications are one of the therapeutic agents that have been explored and utilized in LDDS sas gels. [16]
Figure 8. Gels and their placement.
A thermosensitive injectable gel incorporating erythropoietin and aspirin has demonstrated positive outcomes in long-term medication delivery and periodontal health. This gel is characterized by its high biocompatibility, ease of preparation, and capability to provide a sustained release of the active ingredient for a minimum of 21 days. Furthermore, compelling studies have been conducted on gels that incorporate medications aimed at promoting osteogenesis. In a study examining hyaluronic acid (HA), the biological hydrogel enriched with recombinant human fibroblast growth factor type 2 (rhFGF-2) demonstrated markedly better results. This included a more substantial decrease in probing depth (5.5 mm versus 2.9 mm), improved clinical attachment level increases (4.8 mm compared to 2.2 mm), and a reduced residual probing depth (4.2 mm compared to 6.6 mm) in comparison to the control groups.
Gel Drug Delivery Systems for Treating Periodontitis Have Several Important Characteristics That Enhance Their Effectiveness. Here Are Some Key Features:
Introduction:
Bone resorption is the result of apical biofilm advancement in periodontitis. To fix these kinds of bone defects, it is crucial to promote bone regeneration. Membranes have been created and used to make it feasible. They function as barriers that aid in the healing of periodontal tissues' wounds, and they can be enhanced by certain therapeutic agents, which makes them LDSs. First, membranes that were not biodegradable were used. [3]
Then, as a second surgical procedure was required to remove them, they were gradually abandoned. Currently, growth factors and osteogenesis medications are incorporated into a functional layer of absorbable membranes, which have superseded the older non-resorbable membranes. Modern membranes made from collagen, polyglycolide, polylactide, or their copolymers are employed in guided tissue regeneration (GTR) and periodontal regeneration. Because of its benefits, which include its ability to engage and activate gingival fibroblast cells, prevent immunological reactions, and have hemostatic properties, collagen is the most widely used material. Collagen membranes have been shown to stimulate the synthesis of fibroblast DNA. Additionally, in comparison to other membrane surfaces, osteoblasts exhibit greater adherence to collagen membrane surfaces. A novel core-shell nanofiber membrane has been recently introduced for the treatment of periodontitis. Liu and his team created this membrane by integrating an inhibitor (SP600125) into the polymeric micelles of recombinant human bone morphogenetic protein, as well as into the micelles of the shell. [27]
Figure 9. The membrane and its positioning to function effectively as a barrier.
Membrane Drug Delivery Systems For Treating Periodontitis Have Several Distinctive Characteristics That Enhance Their Therapeutic Effectiveness. Here Are Some Key Features:
Introduction:
Similar to membranes, scaffolds have been introduced to correct defects in the bone. They are better because they do not have the primary drawback of absorbable membranes, which is a weakness that prevents enough mechanical resistance to outside forces. To preserve the area for later periodontal tissue regeneration, they are positioned in the affected area. Tests on a chitosan scaffold loaded with tetracyclines revealed that a higher loading capacity was observed at higher chitosan and glutaraldehyde percentages. Liao & Co. performed an assessment of the osteogenic and cementogenic properties in vitro, in addition to examining the controlled-release and antibacterial features, as well as the in vivo efficacy of a mesoporous hydroxyapatite/chitosan (mHA/CS) composite scaffold infused with recombinant human amelogenin at a concentration of 20 µg/mL (rhAm). The findings demonstrated a significant potential for clinical use, showing an inhibitory effect on Fusobacterium nucleatum and Porphyromonas gingivalis, alongside promoting bone regeneration in vitro and cementum regeneration in vivo. Notably, the small molecule peptide galanin (GAL) was found to have a remarkable influence on periodontal regeneration. The research team led by Ma et al. observed a correlation between periodontal disease and the downregulation of GAL. Examined GAL-coated scaffolds in vivo and in vitro in rats for the purpose of periodontal regeneration. The outcomes showed good potential for periodontal regeneration. Stem cells can be added to and are becoming more significant in periodontal regeneration. [17]
Figure 10. Scaffold and its placement.
Scaffold-Based Systems for Periodontitis Treatment Merge Framework Structures with Medication Release, Enhancing Therapeutic Benefits.
?3D Structure: Scaffolds provide a three-dimensional matrix that supports cell attachment, growth, and tissue regeneration while also serving as a drug delivery platform.
?Biocompatibility: Materials used for scaffolds must be biocompatible to prevent adverse reactions and support healing in periodontal tissues.
?Porosity: A well-designed scaffold has controlled porosity, allowing for nutrient exchange and facilitating the infiltration of cells and tissues while providing space for drug release.
?Regulated Release of Pharmaceuticals: These systems are engineered to deliver therapeutic agents in a controlled manner, ensuring a sustained release over an extended period to maintain effective drug concentrations at the site of infection.
?Mechanical Stability: Scaffold membranes should possess adequate mechanical strength to withstand oral conditions, including mastication and saliva flow, while maintaining their structure during the healing process.
?Adhesiveness: The scaffold should adhere well to the periodontal tissues to ensure prolonged contact with the site of drug action and enhance therapeutic efficacy.
?Incorporation of Bioactive Agents: Scaffolds can be infused with a range of therapeutic agents, including antibiotics, anti-inflammatory medications, or growth factors, customized to meet the particular requirements of treating periodontitis.
?Cellular Interactions: These systems can promote interactions with host cells, facilitating healing, regeneration, and integration with surrounding tissues.
?Degradability: Scaffold membranes are often designed to be biodegradable, allowing them to gradually break down as tissue regenerates, eliminating the need for surgical removal.
?Antimicrobial Properties: Many scaffolds incorporate antimicrobial agents to combat pathogens associated with periodontitis, enhancing their therapeutic effect. [28]?
4.Application Of Local Drug Delivery Systems and Their Modalities:
Figure 11. A schematic diagram illustrating the categorization of Local Drug Delivery Systems (LDDSs) and their respective methods of administration.
1. Applications:
1.1 Periodontitis Treatment:
1.2 Orthopedic Applications:
1.3 Ophthalmology:
1.4 Cancer Therapy:
1.5 Dermatology:
1.6 Pain Management:
1.7 Chronic Wound Management:
2. Modalities:
2.1 Fibers:
2.2 Strips and Films:
2.3 Microparticles:
2.4 Nanosystems:
2.5 Gels:
2.6 Membranes:
2.7 Scaffolds:
5.Current Overview of Advanced Localized Delivery Systems for Periodontitis Treatment:
The importance of intra-pocket delivery devices in periodontics may be questioned because of the wide variety of antimicrobial intra-pocket delivery systems available for periodontal treatment in the current market. Should intra-pocket delivery systems be considered as alternatives to scaling and root planing (SRP) if they demonstrate similar clinical outcomes? Additionally, what role will antimicrobials play in treatment strategies, whether or not mechanical intervention is involved? It is crucial to assess the physical characteristics of the delivery system, as these factors can impact its acceptance by both patients and healthcare professionals. A small number of studies provide evidence for the clinical effectiveness of intra-pocket delivery systems in treating patients with periodontitis, despite the abundance of reports on local delivery techniques found in periodontal literature. [5]
Table 1. The strategic methods alongside the related obstacles and successes in the development of a periodontal drug delivery system.
CONCLUSION:
A significant transformation is taking place in dental pharmacotherapy, transitioning from the use of systemic antibiotics to targeted delivery systems that focus on intra-pocket applications. This shift is motivated by progress in comprehending the molecular mechanisms, bacterial metabolism, and the pathogenesis linked to periodontal infections. Research emphasizing the formation of planktonic biofilms and the resistance of bacteria to different antibiotics has further reinforced the implementation of intra-pocket systems. Dentists are progressively choosing to discontinue the routine use of systemic antibiotics for addressing common dental problems, as a variety of clinical studies indicate that locally administered treatments are effective in improving overall dental health. This advancement lays the groundwork for the future patenting of novel, commercially feasible, and physiologically compatible intra-pocket-targeted drug delivery systems.
ACKNOWLEDGMENT:
We recognize the increasing concern surrounding periodontitis, a serious condition that impacts millions around the globe. We commend the dedication of researchers, scientists, and healthcare professionals who are striving towards its prevention and management. Recent developments in formulation techniques have shown potential in addressing periodontitis. We also express our gratitude to Loknete Dr. J. D. Pawar College of Pharmacy, Manur, Kalwan for providing their facilities and resources. We also extend our gratitude to our guide for their steadfast support. This review seeks to deliver a thorough overview of the latest trends in formulation methods for the treatment of periodontitis, aiming to enhance treatment results and improve patient care.
REFERENCES
Isha Kanoj*, Sonal Jadhav, Yashpal More, Recent Trends on Formulation Approaches for The Treatment of Periodontitis, Int. J. of Pharm. Sci., 2025, Vol 3, Issue 1, 2553-2569. https://doi.org/10.5281/zenodo.14776868
10.5281/zenodo.14776868
