Although the clinical mainstay treatment of periodontitis revolves around the use of various types of antibiotics in addition to other symptomatic relief drugs such as anti-inflammatory drugs and others, the continuous efforts of pharmaceutical researchers have led to the design and development of certain advanced dento-therapeutics which are primarily focused on spatio–temporal drug delivery for a prolonged period
[56]. A recce of concerned literature has revealed the prevalence of various formulation designs focusing on locoregional effects.
Table 1 summarizes the various pharmaceutical research designs with a primary objective of the formulation.
The conventional treatment modalities for periodontal infections primarily focus on dental plaque, which is an oral biofilm responsible for causing various inflammatory reactions in periodontal tissues. Different available approaches to target dental plaque include plaque control, non-surgical, and surgical interventions. Adjuvant therapies such as antibiotics or supplements are also included, although they face major limitations of antibiotic resistance, local inflammation in the periodontium, and host immune responses, thus causing partial effectiveness
[86]. Therefore, advanced strategies to mitigate, treat, and lessen periodontal infections have become a need of the present time. Recently, various modalities such as quorum sensing inhibitors, inflammasome targeting, host inflammatory substances, bone immune responses, and FDA-approved anabolic agents, namely, the teriparatide and sclerostin antibody, have been introduced as a step forward against periodontal infections
[87]. Quorum-sensing inhibitors target molecules that modulate microbial signaling mechanisms, a primary step in biofilm formation, thus inhibiting plaque biofilm formation and controlling periodontal infections
[88]. The inflammasome is a naturally produced cytosolic multiprotein oligomer of the innate immune system. Abnormal inflammasome activation is associated with various ailments including periodontal disease pathogenesis. Thus, the development of drugs that directly target and inhibit an inflammasome activation may hinder the progression of the periodontal infection
[89]. The FDA-approved anabolic agents for bone regeneration could be incorporated with current treatment regimens as dental implants for severe cases of periodontitis
[87]. Reportedly, the use of photodynamic therapy has also gained considerable attention against dental plaque; for example, the potential use of nano-based antibacterial photodynamic therapies to combat bacterial plaque-initiated oral diseases and adjunctive application of antimicrobial photodynamic therapy in nonsurgical periodontal treatment has been noted
[90]. Various developing strategies such as bioactive-based dental polymers, nano-size building blocks, and bio-implants are also being considered as new generation dental restoration tools and can inhibit oral biofilms
[86].