Periodontitis is an inflammatory disease of the gums characterized by the degeneration of periodontal ligaments, the formation of periodontal pockets, and the resorption of the alveolar bone, which results in the destruction of the teeth’s supporting structure. Periodontitis is caused by the growth of diverse microflora (particularly anaerobes) in the pockets, releasing toxins and enzymes and stimulating the immune system. Various approaches, both local and systemic, have been used to treat periodontitis effectively. Successful treatment depends on reducing bacterial biofilm, bleeding on probing (BOP), and reducing or eliminating pockets. Currently, the use of local drug delivery systems (LDDSs) as an adjunctive therapy to scaling and root planing (SRP) in periodontitis is a promising strategy, resulting in greater efficacy and fewer adverse effects by controlling drug release. Selecting an appropriate bioactive agent and route of administration is the cornerstone of a successful periodontitis treatment plan. In this context, this review focuses on applications of LDDSs with varying properties in treating periodontitis with or without systemic diseases to identify current challenges and future research directions.

Periodontitis is a multifactorial and infective oral disease that leads to the destruction of periodontal tissues and tooth loss. Although the treatment of periodontitis has improved recently, the effective treatment of periodontitis and the periodontitis-affected periodontal tissues is still a challenge. Therefore, exploring new therapeutic strategies for a personalized approach is urgent. For this reason, the aim of this study is to summarize recent advances and the potential of oxidative stress biomarkers in the early diagnosis and personalized therapeutic approaches in periodontitis. Recently, ROS metabolisms (ROMs) have been studied in the physiopathology of periodontitis. Different studies show that ROS plays a crucial role in periodontitis. In this regard, the reactive oxygen metabolites (ROMs) started to be searched for the measures of the oxidizing capacity of the plasma understood as the total content of oxygen free radicals (ROS). The oxidizing capacity of plasma is a significant indicator of the body’s oxidant state as well as homocysteine (Hcy), sulfur amino acid, which has pro-oxidant effects as it favors the production of superoxide anion. More specifically, the thioredoxin (TRX) and peroxiredoxin (PRX) systems control reactive oxygen species (ROS), such as superoxide and hydroxyl species, to transduce redox signals and change the activities of antioxidant enzymes to remove free radicals. Superoxide dismutase (SOD), catalase, and glutathione peroxidase (GPx), among other antioxidant enzymes, change their activity when ROS are produced in order to neutralize free radicals. The TRX system is triggered and transduces redox signals to do this.

Periodontal disease is a chronic inflammatory condition affecting about 20–50% of people, worldwide, and manifesting clinically through the detection of gingival inflammation, clinical attachment loss, radiographically assessed resorption of alveolar bone, gingival bleeding upon probing, teeth mobility and their potential loss at advanced stages. It is characterized by a multifactorial etiology, including an imbalance of the oral microbiota, mechanical stress and systemic diseases such as diabetes mellitus. The current standard treatments for periodontitis include eliminating the microbial pathogens and applying biomaterials to treat the bone defects. However, periodontal tissue regeneration via a process consistent with the natural tissue formation process has not yet been achieved. Developmental biology studies state that periodontal tissue is composed of neural crest-derived ectomesenchyme. The aim of this review is to discuss the clinical utility of stem cells in periodontal regeneration by reviewing the relevant literature that assesses the periodontal-regenerative potential of stem cells.

Periodontitis, a chronic multifactorial inflammatory condition of the periodontium, is originated by a dysbiotic oral microbiota and is negatively correlated with several systemic diseases. The low-chronic burden of gingival inflammation not only exacerbates periodontitis but also predisposes individuals to a spectrum of age-related conditions, including cardiovascular diseases, neurodegenerative disorders, and metabolic dysfunction, especially related to ageing. In this regard, over the local periodontal treatment, lifestyle modifications and adjunctive therapies may offer synergistic benefits in ameliorating both oral and systemic health in ageing populations. Elucidating the intricate connections between periodontitis and senescence is important for understanding oral health’s systemic implications for ageing and age-related diseases. Effective management strategies targeting the oral microbiota and senescent pathways may offer novel avenues for promoting healthy ageing and preventing age-related morbidities. This review will analyze the current literature about the intricate interplay between periodontitis, oral dysbiosis, and the processes of senescence, shedding light on their collective impact on the modulation and accelerated ageing and age-related diseases. Lastly, therapeutic strategies targeting periodontitis and oral dysbiosis to mitigate senescence and its associated morbidities will be discussed.

In the last few decades, circulating cell-free DNA (cfDNA) has been shown to have an important role in cell apoptosis or necrosis, including in the development and evolution of several tumors and inflammatory diseases in humans. In this regard, periodontitis, a chronic inflammatory disease that can induce the destruction of supporting components of the teeth, could represent a chronic inflammatory stimulus linked to a various range of systemic inflammatory diseases. Recently, a possible correlation between periodontal disease and cfDNA has been shown, representing new important diagnostic–therapeutic perspectives. During the development of periodontitis, cfDNA is released in biological fluids such as blood, saliva, urine and other body fluids and represents an important index of inflammation. Due to the possibility of withdrawing some of these liquids in a non-invasive way, cfDNA could be used as a possible biomarker for periodontal disease. In addition, discovering a proportional relationship between cfDNA levels and the severity of periodontitis, expressed through the disease extent, could open the prospect of using cfDNA as a possible therapeutic target. The aim of this article is to report what researchers have discovered in recent years about circulating cfDNA in the development, evolution and therapy of periodontitis. The analyzed literature review shows that cfDNA has considerable potential as a diagnostic, therapeutic biomarker and therapeutic target in periodontal disease; however, further studies are needed for cfDNA to be used in clinical practice.

Orthodontic treatment aims to correct malocclusions and ensure the overall health and stability of the periodontium. The relationship between orthodontic therapy and periodontal health is intricate and multifaceted, and a comprehensive approach is often required to achieve optimal outcomes. Firstly, this article delves into the impact of orthodontic mechanics on periodontal tissues, emphasizing the importance of minimizing iatrogenic effects such as root resorption and gingival recession. Understanding the biomechanical principles allows for the development of treatment plans that mitigate these risks while achieving the desired tooth movement. Effective communication and coordinated treatment protocols are essential for managing periodontal issues before, during, and after orthodontic intervention. To optimize outcomes, periodontal considerations such as gingival biotype, attachment levels, and bone support must be integrated into treatment planning. Additionally, adjunctive periodontal therapies such as selective alveolar decortication and regenerative procedures are explored as valuable tools to enhance periodontal support and optimize treatment outcomes. This narrative review explores strategies to attain periodontal goals in orthodontic patients, thereby facilitating successful treatment. Furthermore, the review examines the role of interdisciplinary collaborations between orthodontists and periodontists. In conclusion, achieving periodontal goals in orthodontic patients requires a comprehensive approach that addresses biomechanical principles, interdisciplinary collaboration, patient education, and adjunctive periodontal therapies. By integrating periodontal considerations into orthodontic treatment planning and execution, clinicians can ensure straight teeth and a healthy and stable periodontium, ultimately leading to successful treatment outcomes and long-term oral health.