Current Updates and Future Prospects of Periodontology in India

Recent advancements in clinical diagnosis

Beyond the conceptual understanding of periodontal diseases, significant advancements have been achieved in their clinical and radiographic diagnosis. Accurate diagnosis of periodontal diseases primarily relies on key parameters, including the precise estimation of bleeding on probing (BOP), pocket depth (PD), clinical attachment level (CAL), and radiographic assessment of periodontal bone loss.^[3] Manual probing errors can lead to inaccurate measurements, potentially resulting in misdiagnosis and suboptimal treatment outcomes.^[4] In recent decades, the use of pressure-sensitive probes has emerged as a valuable tool, enabling more accurate and consistent assessment of BOP, PD, and CAL.^[5]

Traditionally, ionizing 2D imaging techniques such as intraoral periapical radiographs (IOPAR), bitewing radiographs, and orthopantomographs (OPG) have been utilized for the assessment of bone loss in patients with periodontitis. In recent years, cone-beam computed tomography (CBCT) has gained recognition as a 3D imaging modality for evaluating bone loss. While its routine use in periodontal diagnosis is not universally endorsed, CBCT may offer valuable insights when combined with 2D imaging and clinical probing.^[6] CBCT is particularly relevant in cases of advanced periodontal disease with coexisting endodontic involvement or for patients being evaluated for dental implant placement.^[7]

Recently, soft tissue CBCT (ST-CBCT) has emerged as an alternative tool for assessing gingival dimensions, offering valuable applications in both perioplastic treatments and dental implant planning.^[8,9] Non-ionizing imaging modalities such as magnetic resonance imaging (MRI), ultrasound, and optical coherence tomography (OCT) have emerged as advanced techniques, offering unique advantages in the visualization and assessment of soft tissues related to periodontal structures.^[6,10] Nevertheless, additional studies are necessary to determine their definitive diagnostic utility in periodontal evaluation, especially due to the limited availability of clinical evidence.

Recent advancements in tissue engineering

The field of periodontal regeneration has witnessed remarkable innovations driven by a deeper understanding of tissue engineering principles. The tissue engineering approach to bone and periodontal regeneration involves the integration of three fundamental components: progenitor cells, which act as the foundation for new tissue formation; a scaffold or supporting matrix, providing the structural framework necessary for cell attachment, growth, and organization; and signaling molecules, which regulate and stimulate cellular processes critical for tissue repair and regeneration.^[11] The utilization of vectors for the delivery of growth factors and proteins has heralded a transformative shift in the field of periodontology. Growth factors such as rhBMP-2, PDGF-α, and TGFβ have been extensively studied and widely utilized in the context of periodontal regeneration.^[12,13]

Recent advancements in 3D printing

Modern digital dentistry is indispensable, with 3D scanning and printing serving as essential technologies in advancing precision and efficiency. Real-time 3D scanning with digital scanners enables clinicians to effectively educate patients about dental issues, fostering greater understanding and motivating timely dental treatment.^[14] In addition, these 3D scans play a crucial role in treatment planning and execution, particularly in dental implants and periodontal regeneration, ensuring greater precision.^[15,16] Recently, 3D scaffolds embedded with growth factor proteins have been utilized to deliver these factors within a customized structure, optimizing regeneration outcomes.^[15] Furthermore, 3D printing of surgical stents has proven to offer superior accuracy compared to traditional thermoplastic stents, enhancing the precision of dental procedures.^[17]

Recent advancements in minimally invasive periodontal surgery

Significant breakthroughs have been made in periodontal surgery, particularly in the areas of periodontal regeneration and aesthetic procedures. The incorporation of Minimally Invasive Surgery (MIS) principles in the field of periodontology has led to remarkable improvements in both surgical outcomes and post-operative patient comfort.^[18] Additionally, the use of loupes and surgical microscopes has further enhanced surgical precision, ensuring better results while adhering to the principles of MIS.

Recent advancements in nanotechnology

Nanotechnology can be defined as ‘the science and engineering involved in the design, synthesis, characterization, and application of materials and devices whose smallest functional organization, in at least one dimension, is on the nanometer scale or one billionth of a meter.’^[19] Nanoparticles are being explored for localized drug delivery^[20], while nanorobots hold promise for applications such as oral pain relief and targeted drug administration. Bioactive glass, carbon nanomaterials, titanium nanotube-coated dental implants, and nanoceramics play a crucial role in bone regeneration and are also used to create scaffolds for regenerating the periodontium.^[21]

Recent advancements in artificial intelligence

AI refers to ‘the simulation of human intelligence in machines that are programmed to think and learn like humans.’ In periodontics, AI applications are designed to assist dental professionals in treatment planning, diagnosis, and prediction of treatment outcomes”.^[22] Presently, AI tools have been extensively studied in periodontal diagnosis, especially in estimation of bone loss in radiographs. Panoramic radiographs, coupled with convolutional neural networks, an AI tool, have detected periodontal bone damage with results comparable to those of experienced clinicians.^[23]