Antimicrobial photocatalysis using bio-hydrothermally synthesized Zinc oxide nanoparticles in the management of periodontitis: a prospective split-mouth, double-blind, randomized, controlled clinical trial

MATHEW, C. Afigith; VEENA, H. R.; SHUBHA, P.; DANIEL, Riya Achamma

doi:10.1590/1678-7757-2023-0271

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Journal of Applied Oral Science

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Original Article • J. Appl. Oral Sci. 31 • 2023 • https://doi.org/10.1590/1678-7757-2023-0271 copy

Antimicrobial photocatalysis using bio-hydrothermally synthesized Zinc oxide nanoparticles in the management of periodontitis: a prospective split-mouth, double-blind, randomized, controlled clinical trial^* * This article is derived from the first author’s dissertation.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The antimicrobial activity of metallic nanoparticles (NPs) has been confirmed to fight a broad spectrum of microorganisms, through antimicrobial effects that are amplified when these particles are irradiated with light of the proper wavelength. This is the first study to use phytoconjugated Zinc oxide (ZnO) NPs containing traces of active biomolecules derived from Emblica officinalis (E. officinalis) plant extract in antimicrobial photocatalysis (PCT) during non-surgical periodontal therapy.

Objectives

This study aimed to evaluate the effects of repeated PCT application in the treatment of periodontitis, using a gel containing bio-hydrothermally synthesized ZnO NPs and visible light as an adjunct to scaling and root planing (SRP).

Methodology

In total, 16 systemically healthy volunteers with stage 3 grade B generalized periodontitis were recruited for this prospective double blind, randomized placebo-controlled trial. After receiving SRP, the subjects received the following interventions in a split-mouth design at baseline, 1 week and 1 month: Group 1 – Placebo gel + Sham PCT; Group 2 – Nano ZnO gel + Sham PCT; Group 3 – Placebo gel + PCT; and Group 4 – Nano ZnO gel + PCT. The site-specific profile of Porphyromonas gingivalis in the subgingival plaque and clinical parameters (Plaque Index, Gingival Index, Gingival Bleeding Index, Probing pocket Depth and Clinical Attachment Level) were assessed at baseline, 1 month and 3 months.

Results

All interventions tested caused participants’ clinical and microbiological parameters to generally improve after 3 months. Subjects who received the Nano ZnO gel + PCT combination showed a sustained and progressive improvement in their treatment outcomes, a result that presented statistically significant differences from the outcomes obtained through the remaining interventions, at all time points during the study period.

Conclusions

The repeated application of PCT using bio-hydrothermally synthesized ZnO NPs can effectively complement SRP in the non-surgical treatment of Periodontitis.

Periodontitis; Photocatalysis; Visible light; Zinc Oxide; Nanoparticles

Parameter	Groups	Baseline		1 Month		3 Months		P-Value	Wilcoxon Post hoc Test
		Mean	SD	Mean	SD	Mean	SD		BL vs 1M	BL vs 3M	1M vs 3M
P. gingivalis	Group 1	178002.1	216512.4	154843.3	217116.2	177580.3	216788.1	0.02*	0.04*	0.72	0.04*
	Group 2	269618.8	278931.7	232118.8	238037.3	261675	267559.1	<0.001*	0.01*	0.005*	0.001*
	Group 3	160087.5	159362.3	104512.5	104511	124700	123257.9	<0.001*	0.001*	<0.001*	<0.001*
	Group 4	210931.8	249465.7	93279.2	108003.8	82412.5	92443.8	<0.001*	0.001*	<0.001*	0.29

Timepoint	Groups	N	P. gingivalis
			Mean	SD	Mean Diff	P-Value
Baseline	Group 1	16	178002.1	216512.4	-91616.6	0.38
	Group 2	16	269618.8	278931.7	-91616.6	0.38
	Group 1	16	178002.1	216512.4	17914.6	0.8
	Group 3	16	160087.5	159362.3	17914.6	0.8
	Group 1	16	178002.1	216512.4	-32929.7	0.36
	Group 4	16	210931.8	249465.7	-32929.7	0.36
	Group 2	16	269618.8	278931.7	109531.3	0.3
	Group 3	16	160087.5	159362.3	109531.3	0.3
	Group 2	16	269618.8	278931.7	58686.9	0.5
	Group 4	16	210931.8	249465.7	58686.9	0.5
	Group 3	16	160087.5	159362.3	-50844.3	0.72
	Group 4	16	210931.8	249465.7	-50844.3	0.72
1 Month	Group 1	16	154843.3	217116.2	-77275.5	0.35
	Group 2	16	232118.75	238037.28	-77275.5	0.35
	Group 1	16	154843.3	217116.2	50330.8	0.96
	Group 3	16	104512.5	104511	50330.8	0.96
	Group 1	16	154843.3	217116.2	61564.1	0.13
	Group 4	16	93279.2	108003.8	61564.1	0.13
	Group 2	16	232118.75	238037.28	127606.3	0.1
	Group 3	16	104512.5	104511	127606.3	0.1
	Group 2	16	232118.75	238037.28	138839.6	0.06
	Group 4	16	93279.2	108003.8	138839.6	0.06
	Group 3	16	104512.5	104511	11233.3	0.76
	Group 4	16	93279.2	108003.8	11233.3	0.76
3 Months	Group 1	16	177580.3	216788.1	-84094.8	0.36
	Group 2	16	261675	267559.1	-84094.8	0.36
	Group 1	16	177580.3	216788.1	52880.3	0.57
	Group 3	16	124700	123257.9	52880.3	0.57
	Group 1	16	177580.3	216788.1	95167.8	0.02*
	Group 4	16	82412.5	92443.8	95167.8	0.02*
	Group 2	16	261675	267559.1	136975	0.07
	Group 3	16	124700	123257.9	136975	0.07
	Group 2	16	261675	267559.1	179262.5	0.04*
	Group 4	16	82412.5	92443.8	179262.5	0.04*
	Group 3	16	124700	123257.9	42287.5	0.3
	Group 4	16	82412.5	92443.8	42287.5	0.3

Parameter	Group	Baseline		1 Month		3 Months		P-Value	Bonferroni's Post hoc Test
		Mean	SD	Mean	SD	Mean	SD		BL vs 1M	BL vs 3M	1M vs 3M
PI	Group 1	2.44	0.43	1.27	0.99	2.09	1.04	0.01*	<0.001*	0.85	0.19
	Group 2	2.53	0.43	0.78	0.68	2.23	0.94	<0.001*	<0.001*	0.98	0.006*
	Group 3	2.31	0.46	0.72	0.73	1.81	0.72	<0.001*	<0.001*	0.1	0.003*
	Group 4	2.39	0.5	1.27	0.57	0.61	0.69	<0.001*	<0.001*	<0.001*	0.06
GI	Group 1	2.31	0.46	1.31	0.86	2.11	0.87	0.01*	<0.001*	1	0.14
	Group 2	2.44	0.43	0.78	0.55	2.16	1.06	<0.001*	<0.001*	1	0.006*
	Group 3	2.39	0.5	0.73	0.45	1.61	0.82	<0.001*	<0.001*	0.009*	0.02*
	Group 4	2.53	0.43	1.27	0.82	0.69	0.67	<0.001*	<0.001*	<0.001*	0.28
PPD	Group 1	4.59	1.24	4.07	1.32	4.56	1.22	0.02*	0.002*	1	0.15
	Group 2	4.35	1.08	3.66	1.02	4.23	0.93	0.01*	<0.001*	1	0.1
	Group 3	4.56	1.27	3.67	0.91	3.96	0.98	0.007*	<0.001*	0.18	0.44
	Group 4	4.44	1.05	3.68	0.88	3.16	0.94	<0.001*	<0.001*	<0.001*	0.13
CAL	Group 1	5.28	1.63	3.47	1.72	4.63	1.32	0.004*	<0.001*	0.62	0.14
	Group 2	4.99	1.02	2.84	0.87	4.63	1.54	<0.001*	<0.001*	1	0.009*
	Group 3	5.06	1.16	2.93	0.84	4.37	1.39	<0.001*	<0.001*	0.04*	0.002*
	Group 4	5.38	1.48	3.53	0.53	3.13	0.78	<0.001*	<0.001*	<0.001*	0.43

Parameter	Groups	Baseline		1 Month		3 Months		P-Value	Wilcoxon Post hoc Test
		Mean	SD	Mean	SD	Mean	SD		BL vs 1M	BL vs 3M	1M vs 3M
GBI	Group 1	83.34	14.89	59.38	21.93	78.12	23.34	0.002*	<0.001*	1	0.06
	Group 2	82.29	14.22	48.23	24.76	82.17	20.28	0.001*	<0.001*	1	0.008*
	Group 3	84.38	14.22	36.45	24.5	63.54	28.69	<0.001*	<0.001*	0.03*	0.01*
	Group 4	85.41	13.43	48.96	21.49	36.46	28.68	<0.001*	<0.001*	<0.001*	0.47

Timepoint	Groups	N	PI				GI				PPD				CAL
			Mean	SD	Mean Diff	P-Value	Mean	SD	Mean Diff	P-Value	Mean	SD	Mean Diff	P-Value	Mean	SD	Mean Diff	P-Value
Baseline	Group 1	16	2.44	0.43	-0.09	0.58	2.31	0.46	-0.13	0.43	4.59	1.24	0.24	0.38	5.28	1.63	0.29	0.44
	Group 2	16	2.53	0.43			2.44	0.43			4.35	1.08			4.99	1.02
	Group 1	16	2.44	0.43	0.13	0.43	2.31	0.46	-0.08	0.71	4.59	1.24	0.03	0.94	5.28	1.63	0.23	0.67
	Group 3	16	2.31	0.46			2.39	0.5			4.56	1.27			5.06	1.16
	Group 1	16	2.44	0.43	0.05	0.78	2.31	0.46	-0.22	0.24	4.59	1.24	0.15	0.75	5.28	1.63	-0.09	0.87
	Group 4	16	2.39	0.5			2.53	0.43			4.44	1.05			5.38	1.48
	Group 2	16	2.53	0.43	0.22	0.24	2.44	0.43	0.05	0.78	4.35	1.08	-0.21	0.41	4.99	1.02	-0.06	0.83
	Group 3	16	2.31	0.46			2.39	0.5			4.56	1.27			5.06	1.16
	Group 2	16	2.53	0.43	0.14	0.29	2.44	0.43	-0.09	0.58	4.35	1.08	-0.09	0.76	4.99	1.02	-0.38	0.42
	Group 4	16	2.39	0.5			2.53	0.43			4.44	1.05			5.38	1.48
	Group 3	16	2.31	0.46	-0.08	0.71	2.39	0.5	-0.14	0.29	4.56	1.27	0.12	0.62	5.06	1.16	-0.32	0.36
	Group 4	16	2.39	0.5			2.53	0.43			4.44	1.05			5.38	1.48
1 Month	Group 1	16	1.27	0.99	0.49	0.04*	1.31	0.86	0.53	0.03*	4.07	1.32	0.41	0.09	3.47	1.72	0.63	0.19
	Group 2	16	0.78	0.68			0.78	0.55			3.66	1.02			2.84	0.87
	Group 1	16	1.27	0.99	0.55	0.11	1.31	0.86	0.58	0.03*	4.07	1.32	0.4	0.3	3.47	1.72	0.54	0.2
	Group 3	16	0.72	0.73			0.73	0.45			3.67	0.91			2.93	0.84
	Group 1	16	1.27	0.99	0	1	1.31	0.86	0.05	0.88	4.07	1.32	0.39	0.36	3.47	1.72	-0.06	0.9
	Group 4	16	1.27	0.57			1.27	0.82			3.68	0.88			3.53	0.53
	Group 2	16	0.78	0.68	0.06	0.77	0.78	0.55	0.05	0.73	3.66	1.02	-0.01	0.98	2.84	0.87	-0.09	0.59
	Group 3	16	0.72	0.73			0.73	0.45			3.67	0.91			2.93	0.84
	Group 2	16	0.78	0.68	-0.49	0.06	0.78	0.55	-0.49	0.11	3.66	1.02	-0.01	0.97	2.84	0.87	-0.69	0.01*
	Group 4	16	1.27	0.57			1.27	0.82			3.68	0.88			3.53	0.53
	Group 3	16	0.72	0.73	-0.55	0.04*	2.16	1.06	1.47	<0.001*	3.67	0.91	-0.01	0.98	2.93	0.84	-0.6	0.04*
	Group 4	16	1.27	0.57			0.69	0.67			3.68	0.88			3.53	0.53
3 Months	Group 1	16	2.09	1.04	-0.14	0.62	2.11	0.87	-0.05	0.9	4.56	1.22	0.33	0.39	4.63	1.32	0	1
	Group 2	16	2.23	0.94			2.16	1.06			4.23	0.93			4.63	1.54
	Group 1	16	2.09	1.04	0.28	0.47	2.11	0.87	0.5	0.09	4.56	1.22	0.6	0.09	4.63	1.32	0.26	0.51
	Group 3	16	1.81	0.72			1.61	0.82			3.96	0.98			4.37	1.39
	Group 1	16	2.09	1.04	1.49	<0.001*	2.11	0.87	1.42	<0.001*	4.56	1.22	1.39	0.002*	4.63	1.32	1.5	0.001*
	Group 4	16	0.61	0.69			0.69	0.67			3.16	0.94			3.13	0.78
	Group 2	16	2.23	0.94	0.42	0.21	2.16	1.06	0.55	0.08	4.23	0.93	0.27	0.33	4.63	1.54	0.26	0.6
	Group 3	16	1.81	0.72			1.61	0.82			3.96	0.98			4.37	1.39
	Group 2	16	2.23	0.94	1.63	<0.001*	2.16	1.06	1.47	<0.001*	4.23	0.93	1.06	0.004*	4.63	1.54	1.5	0.007*
	Group 4	16	0.61	0.69			0.69	0.67			3.16	0.94			3.13	0.78
	Group 3	16	1.81	0.72	1.2	0.001*	1.61	0.82	0.92	0.002*	3.96	0.98	0.79	0.03*	4.37	1.39	1.24	0.004*
	Group 4	16	0.61	0.69			0.69	0.67			3.16	0.94			3.13	0.78

Timepoint	Groups	N	GBI
			Mean	SD	Mean Diff	P-Value
Baseline	Group 1	16	83.34	14.89	1.04	0.88
	Group 2	16	82.29	14.22	1.04	0.88
	Group 1	16	83.34	14.89	-1.04	0.84
	Group 3	16	84.38	14.22	-1.04	0.84
	Group 1	16	83.34	14.89	-2.08	0.67
	Group 4	16	85.41	13.43	-2.08	0.67
	Group 2	16	82.29	14.22	-2.08	0.73
	Group 3	16	84.38	14.22	-2.08	0.73
	Group 2	16	82.29	14.22	-3.12	0.51
	Group 4	16	85.41	13.43	-3.12	0.51
	Group 3	16	84.38	14.22	-1.04	0.79
	Group 4	16	85.41	13.43	-1.04	0.79
1 Month	Group 1	16	59.38	21.93	11.14	0.19
	Group 2	16	48.23	24.76	11.14	0.19
	Group 1	16	59.38	21.93	22.93	0.01*
	Group 3	16	36.45	24.5	22.93	0.01*
	Group 1	16	59.38	21.93	10.42	0.25
	Group 4	16	48.96	21.49	10.42	0.25
	Group 2	16	48.23	24.76	11.78	0.19
	Group 3	16	36.45	24.5	11.78	0.19
	Group 2	16	48.23	24.76	-0.73	0.94
	Group 4	16	48.96	21.49	-0.73	0.94
	Group 3	16	36.45	24.5	-12.51	0.19
	Group 4	16	48.96	21.49	-12.51	0.19
3 Months	Group 1	16	78.12	23.34	-4.05	0.54
	Group 2	16	82.17	20.28	-4.05	0.54
	Group 1	16	78.12	23.34	14.58	0.12
	Group 3	16	63.54	28.69	14.58	0.12
	Group 1	16	78.12	23.34	41.66	<0.001*
	Group 4	16	36.46	28.68	41.66	<0.001*
	Group 2	16	82.17	20.28	18.63	0.08
	Group 3	16	63.54	28.69	18.63	0.08
	Group 2	16	82.17	20.28	45.71	<0.001*
	Group 4	16	36.46	28.68	45.71	<0.001*
	Group 3	16	63.54	28.69	27.09	0.01*
	Group 4	16	36.46	28.68	27.09	0.01*

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[1] Corresponding address: Dr. Veena H. R. Department of Periodontics - K. L. E. Society’s Institute of Dental Sciences - Bangalore - Karnataka - Pincode: 560022 - India. Phone no: +919480516011. e-mail: drveenahr@gmail.com

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Antimicrobial photocatalysis using bio-hydrothermally synthesized Zinc oxide nanoparticles in the management of periodontitis: a prospective split-mouth, double-blind, randomized, controlled clinical trial* * This article is derived from the first author’s dissertation.

Abstract

Objectives

Methodology

Results

Conclusions

Antimicrobial photocatalysis using bio-hydrothermally synthesized Zinc oxide nanoparticles in the management of periodontitis: a prospective split-mouth, double-blind, randomized, controlled clinical trial^* * This article is derived from the first author’s dissertation.