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Abordagens inovadoras no tratamento da periodontite: uma revisão integrativa
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A periodontite é uma doença inflamatória crónica que afeta as estruturas de suporte dos dentes, levando à perda de inserção e eventual perda dentária. O tratamento convencional envolve desbridamento mecânico e terapia antimicrobiana sistémica ou local. No entanto, devido às crescentes preocupações com a resistência aos antibióticos e à complexidade dos biofilmes periodontais, novas estratégias terapêuticas têm sido cada vez mais investigadas. O objetivo desta revisão integrativa foi avaliar a eficácia clínica de abordagens terapêuticas inovadoras como adjuvantes do tratamento periodontal não cirúrgico (NSPT), em comparação com as modalidades de tratamento tradicionais. Foi efetuado uma pesquisa bibliográfica nas bases de dados PubMed e Cochrane utilizando os termos “periodontite”, “doença periodontal”, “novas abordagens terapêuticas” e “estratégias terapêuticas inovadoras”, combinados com operadores booleanos. Os critérios de inclusão compreenderam ensaios clínicos publicados entre 2020 e 2024, escritos em inglês e conduzidos em populações humanas. No total, foram selecionados 11 estudos seguindo as diretrizes PRISMA. A revisão da literatura selecionada identificou uma variedade de tratamentos adjuvantes promissores. Os probióticos demonstraram melhorias clínicas e microbiológicas, com alguns estudos a apresentarem resultados comparáveis à clorohexidina. Os fitoterápicos como o Semelil mostraram propriedades anti-inflamatórias e antioxidantes, resultando numa melhor profundidade de sondagem e nível de inserção clínica. O plasma de pressão atmosférica não-térmica foi associado a reduções significativas no Hemorragia à sondagem e nos marcadores inflamatórios, apoiando o seu potencial para a descontaminação da bolsa. A terapia laser com lasers de díodo de 445 nm melhorou os resultados clínicos quando utilizada em conjunto com a raspagem e alisamento radicular. Da mesma forma, o uso adjuvante de terapia fotodinâmica antimicrobiana (aPDT) com indocianina verde levou a reduções superiores na carga bacteriana e nos índices clínicos em comparação com o NSPT isolado. O ácido hialurónico e a suplementação antioxidante com melatonina e vitamina C também apresentaram melhorias estatisticamente significativas nos parâmetros clínicos. Por fim, os sistemas de polimento a ar à base de eritritol demonstraram uma eficácia comparável ao desbridamento mecânico tradicional em pacientes com baixa atividade periodontal. Os resultados dos estudos revistos sugerem que estas novas terapêuticas adjuvantes podem aumentar significativamente a eficácia do NSPT convencional. Entre elas, os probióticos e as estratégias baseadas em antioxidantes são particularmente promissores devido à sua compatibilidade biológica e efeitos secundários mínimos. As aplicações de NAPP e laser oferecem opções precisas e minimamente invasivas com efeitos antimicrobianos notáveis. Embora os resultados sejam encorajadores, mais ensaios clínicos randomizados de longo prazo e em larga escala são essenciais para confirmar a sua utilidade clínica e a integração na terapêutica periodontal de rotina.
Periodontitis is a chronic inflammatory disease that affects the supporting structures of the teeth, leading to loss of attachment and eventual tooth loss. Conventional treatment involves mechanical debridement and systemic or local antimicrobial therapy. However, due to increasing concerns about antibiotic resistance and the complexity of periodontal biofilms, new therapeutic strategies have been increasingly investigated. The aim of this integrative review was to evaluate the clinical efficacy of innovative therapeutic approaches as adjuncts to non-surgical periodontal treatment (NSPT), compared with traditional treatment modalities. A literature search was performed in the PubMed and Cochrane databases using the terms “periodontitis”, “periodontal disease”, “new therapeutic approaches” and “innovative therapeutic strategies”, combined with Boolean operators. Inclusion criteria comprised clinical trials published between 2020 and 2024, written in English and conducted in human populations. A total of 11 studies were selected following the PRISMA guidelines. Review of the selected literature identified a variety of promising adjunctive treatments. Probiotics have demonstrated clinical and microbiological improvements, with some studies showing comparable results to chlorhexidine. Herbal remedies such as Semelil have shown anti-inflammatory and antioxidant properties, resulting in improved probing depth and clinical attachment level. NAPP was associated with significant reductions in bleeding on probing and inflammatory markers, supporting its potential for pocket decontamination. Laser therapy with 445 nm diode lasers improved clinical outcomes when used in conjunction with scaling and root planing. Similarly, adjunctive use of antimicrobial photodynamic therapy (aPDT) with indocyanine green led to superior reductions in bacterial load and clinical indices compared with NSPT alone. Hyaluronic acid and antioxidant supplementation with melatonin and vitamin C also showed statistically significant improvements in clinical parameters. Finally, erythritol-based air polishing systems demonstrated comparable efficacy to traditional mechanical debridement in patients with low periodontal activity. The results of the reviewed studies suggest that these novel adjunctive therapies may significantly enhance the efficacy of conventional NSPT. Among them, probiotics and antioxidant-based strategies are particularly promising due to their biological compatibility and minimal side effects. Non-thermal plasma and laser applications offer precise and minimally invasive options with remarkable antimicrobial effects. Although the results are encouraging, further long-term and large-scale randomized clinical trials are essential to confirm their clinical utility and integration into routine periodontal therapy.
Periodontitis is a chronic inflammatory disease that affects the supporting structures of the teeth, leading to loss of attachment and eventual tooth loss. Conventional treatment involves mechanical debridement and systemic or local antimicrobial therapy. However, due to increasing concerns about antibiotic resistance and the complexity of periodontal biofilms, new therapeutic strategies have been increasingly investigated. The aim of this integrative review was to evaluate the clinical efficacy of innovative therapeutic approaches as adjuncts to non-surgical periodontal treatment (NSPT), compared with traditional treatment modalities. A literature search was performed in the PubMed and Cochrane databases using the terms “periodontitis”, “periodontal disease”, “new therapeutic approaches” and “innovative therapeutic strategies”, combined with Boolean operators. Inclusion criteria comprised clinical trials published between 2020 and 2024, written in English and conducted in human populations. A total of 11 studies were selected following the PRISMA guidelines. Review of the selected literature identified a variety of promising adjunctive treatments. Probiotics have demonstrated clinical and microbiological improvements, with some studies showing comparable results to chlorhexidine. Herbal remedies such as Semelil have shown anti-inflammatory and antioxidant properties, resulting in improved probing depth and clinical attachment level. NAPP was associated with significant reductions in bleeding on probing and inflammatory markers, supporting its potential for pocket decontamination. Laser therapy with 445 nm diode lasers improved clinical outcomes when used in conjunction with scaling and root planing. Similarly, adjunctive use of antimicrobial photodynamic therapy (aPDT) with indocyanine green led to superior reductions in bacterial load and clinical indices compared with NSPT alone. Hyaluronic acid and antioxidant supplementation with melatonin and vitamin C also showed statistically significant improvements in clinical parameters. Finally, erythritol-based air polishing systems demonstrated comparable efficacy to traditional mechanical debridement in patients with low periodontal activity. The results of the reviewed studies suggest that these novel adjunctive therapies may significantly enhance the efficacy of conventional NSPT. Among them, probiotics and antioxidant-based strategies are particularly promising due to their biological compatibility and minimal side effects. Non-thermal plasma and laser applications offer precise and minimally invasive options with remarkable antimicrobial effects. Although the results are encouraging, further long-term and large-scale randomized clinical trials are essential to confirm their clinical utility and integration into routine periodontal therapy.
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Palavras-chave
Periodontite Novas abordagens terapêuticas Probióticos Plasma não térmico Terapia fotodinâmica Laser Fitoterapia Ácido hialurónico Periodontitis Novel therapeutic approaches Probiotics Non-thermal plasma Photodynamic therapy Phytotherapy Hyaluronic acid