Evaluation of clinical efficacy of scaling and root planing with copper nanoparticles gel and/or chlorhexidine gel in patients with periodontitis: A randomized control trial

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Resistance to antibiotic mechanisms, such as regulation of permeability, multi-drug efflux pumps, antibiotic disintegration, and target area attraction, are dealt with by nanoparticles. These NPs are composed of Ag and Cu as heavy metals. Being both an essential nutrient as well as an especially hazardous matter, copper represents the two poles of the survival range for microorganisms. Because copper fittings and work surfaces are capable of eliminating methicillin-resistant S. aureus (MRSA) to prevent cross-contamination,they act as an additional obstacle. Additional research is needed, as the mode of action of nanoparticles is not fully understood. Existing information concerning NPs encourages further research to explore their use in the control of dental infections." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-315", "name": "Evaluation of clinical efficacy of scaling and root planing with copper..." } } ] } Home Browse Evaluation of clinical efficacy of scaling and root planing with copper... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Mahale S and Dhadse P. Evaluation of clinical efficacy of scaling and root planing with copper nanoparticles gel and/or chlorhexidine gel in patients with periodontitis: A randomized control trial [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :315 ( https://doi.org/10.12688/f1000research.148859.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Study Protocol Clinical trial Evaluation of clinical efficacy of scaling and root planing with copper nanoparticles gel and/or chlorhexidine gel in patients with periodontitis: A randomized control trial [version 1; peer review: 1 approved with reservations] Swapna Mahale https://orcid.org/0000-0003-4882-1740 1 , Prasad Dhadse https://orcid.org/0000-0002-3127-3816 2 Swapna Mahale https://orcid.org/0000-0003-4882-1740 1 , Prasad Dhadse https://orcid.org/0000-0002-3127-3816 2 PUBLISHED 23 Apr 2024 Author details Author details 1 Periodontology, Sharad Pawar Dental College, DMIHER, Wardha/Sawangi, India 2 Periodontology, Sharad Pawar Dental College, DMIHER, Wardha,Sawangi, India Swapna Mahale Roles: Conceptualization, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing Prasad Dhadse Roles: Formal Analysis, Project Administration, Supervision, Validation, Visualization, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Datta Meghe Institute of Higher Education and Research collection. Abstract Antibiotic resistance of bacteria to medications can be resolved using nanotechnology. Resistance to antibiotic mechanisms, such as regulation of permeability, multi-drug efflux pumps, antibiotic disintegration, and target area attraction, are dealt with by nanoparticles. These NPs are composed of Ag and Cu as heavy metals. Being both an essential nutrient as well as an especially hazardous matter, copper represents the two poles of the survival range for microorganisms. Because copper fittings and work surfaces are capable of eliminating methicillin-resistant S. aureus (MRSA) to prevent cross-contamination,they act as an additional obstacle. Additional research is needed, as the mode of action of nanoparticles is not fully understood. Existing information concerning NPs encourages further research to explore their use in the control of dental infections. READ ALL READ LESS Keywords Copper nanoparticles, Local Drug Delivery, Periodontitis , Randomized Clinical Trial, Scaling ,Root Planing Corresponding Author(s) Swapna Mahale ( [email protected] ) Prasad Dhadse ( [email protected] ) Close Corresponding authors: Swapna Mahale, Prasad Dhadse Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Mahale S and Dhadse P. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Mahale S and Dhadse P. Evaluation of clinical efficacy of scaling and root planing with copper nanoparticles gel and/or chlorhexidine gel in patients with periodontitis: A randomized control trial [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :315 ( https://doi.org/10.12688/f1000research.148859.1 ) First published: 23 Apr 2024, 13 :315 ( https://doi.org/10.12688/f1000research.148859.1 ) Latest published: 23 Apr 2024, 13 :315 ( https://doi.org/10.12688/f1000research.148859.1 ) Introduction Periodontitis is a complex microbial disease with dental plaque as its primary etiological agent. The intricate connections of the biofilm with the host inflammatory reaction as a disease expression leads to a reduction in bone and connective tissue destruction in chronic periodontitis. 1 It is likely that certain types of periodontal disease affect more than 90% of the population. In patients with periodontitis, mechanical therapy alone sometimes fails to remove periodontopathic microorganisms. Whenever gingival inflammation continues or reverts, it leads to loss of periodontal attachment. 2 Hence, antimicrobial therapy can be used as a supportive remedy in the treatment of periodontal infection. The disadvantages of systemic antibiotic therapy, such as organ toxicity and higher required dosage to attain optimum GCF concentration at the target site, have directed the practice of local drug delivery systems. The intra-pocket administration of antimicrobial agents has aroused great concern, as it restrict systemic antimicrobial therapy and is regarded as a local site-specific procedure. 3 The local drug is retained in the periodontal pocket, which acts as a pool for periodontal pathogens. Various local drug delivery agents, such as chlorhexidine gluconate, doxycycline hyclate, minocycline hydrochloride, and tetracycline fibers, have been approved for use in periodontal pockets. 4 Despite the clinical efficacy of tetracycline, fiber placement is complex and requires time with transitory gingival irritation for removal. In contrast, scaling and root planing with local doxycycline therapy did not enhance the benefits of the mechanical treatment alone. 5 Chlorhexidine has been used as a gold standard local drug delivery antimicrobial agent for a long time. It is often used in dentistry owing to its robust and wide-ranging antibacterial effects. It is a strong antiseptic bisguanide that possesses bacteriostatic and bactericidal properties at pH above 3.5. Its dicationic structure is positively charged. It maintains the substantivity characteristic, which enables it to reside attached to a number of tissues and provides an 8–12 h antibacterial activity. 6 However, there are some inevitable side effects of chlorhexidine-like brown staining on tooth surfaces, restorative materials, the dorsum of the tongue, taste alterations, oral mucosal erosion, and swelling of the parotid glands. 7 Nanotechnology provides an avenue for combating antibiotic-resistant microorganisms . Antibiotic resistance mechanisms, which include regulation of permeation, multi-drug pumps for efflux, breakdown of antibiotics, and alterations in intended location binding capacity, are dealt with by nanoparticles. 8 Although copper fittings and work surfaces can swiftly eradicate methicillin-resistant S. aureus (MRSA), as they constitute an additional barrier to avoid cross-contamination. 9 , 10 On the viability range for microorganisms, copper is a vital nutrient and a intensely lethal substance at the other end. Almost all the metals utilized to make these NPs are heavy metals, such as Ag and Cu. More research is needed since the path for action that nanoparticles detect is not fully comprehended. 11 , 12 An effective clinical trial is planned to assess the benefits in addition to safety. The current knowledge of NPs requires further research to develop prospective applications of NPs in the control of dental infections. Aim To measure the clinical outcomes of a local drug delivery agent (copper nanoparticle gel against chlorhexidine gel) with scaling and root planing in patients with periodontitis. Objective To assess the clinical efficacy using the Papillary Bleeding Index (PBI), Modified Plaque Index (PI), Probing Pocket Depth (PPD), and Relative Attachment Level (RAL) after scaling and root planing with copper nanoparticles and/or chlorhexidine gel in patients with periodontitis. Material Copper nanoparticles (particle size 30-50nm) were procured from the Nano Research Laboratory, Jharkhand, India, provided with the safety data sheet and analysis. Preparation of CU-NP gels Copper nanoparticles (0.005% w/v) were added to (1% w/v) weighed Carbopol 934 (soaked overnight in distilled water at 4°C) and mixed thoroughly. Methyl paraben (0.18% w/v) and propyl paraben (0.02% w/v) were added as preservatives and 1N NaOH solution was added drop wise to the above dispersion until it formed gel. The gel was refrigerated in airtight containers for further studies. The gel possessed a smooth, homogeneous texture and was free of gritty particle with transparent colour. 13 Methods Study setting Inclusion criteria : The study will involve participants who have been diagnosed with generalized periodontitis stage 2 grade B and who do not have any risk factors (2017, World Workshop, classification of periodontal and peri-implant diseases and disorders). The patients were willing to provide written informed consent and cooperate with the protocol. The primary investigator will obtain informed consent for this prospective study. Exclusion criteria : Participants will not be allowed to participate if they have undergone periodontal therapy, antibiotic or antiseptic therapy, bleeding disorders, immunosuppressive medication therapy, or any other systemic diseases that may influence the development of periodontal disease within six months of the start of the study. Sample size Recruitment of patients Power analysis was performed using G*Power, version 3.0.1 (Franz Faul University, Kiel, Germany). The total determined minimum sample size was 38 rounded to 40 individuals (i.e., 20 individuals in each research subgroup) with an effect size of 0.95 and a level of significance of 0.5. See Table 1 for a schedule of events. Table 1. Schedule of events. 14 STUDY PERIOD Enrolment Allocation Post-allocation TIMEPOINT** Screening 1 st visit After 1 month (Baseline) 1 month 3 months Eligibility screen X Informed consent X Inclusion Exclusion criteria X Randomisation X Scaling and root planing X INTERVENTIONS Copper nanoparticles gel delivery X Chlorhexidine gel delivery X ASSESSMENTS Papillary bleeding index X X X Modified plaque index X X X Probing pocket depth X X X Clinical attachment level X X X Allocation The auxiliary staff will hand over the patient’s material after reading the randomization sheet. The study’s details, randomization code, and information regarding the allocation of treatments, such as tests or products, will be provided to the auxiliary staff, the randomization sheet. After reviewing the randomization sheet, the auxiliary staff dispensed the material to the patient. Concealment mechanism : Envelopes will be prepared with an explicitly specified randomized treatment that complies with the participant’s randomization schedule. The only person with access to any of the envelopes at the location is the PI of the subject(s). Participants : Potential subjects will be made aware of the fact that those who agree to participate in the study will do so voluntarily. Written informed consent will be obtained before beginning any investigation. Participants presenting with any other emergency dental needs will be attended before the commencement of the study. Their periodontal and gingival conditions, dental hygiene habits, and other standard clinical data will be documented on meticulously created proforma. Subjects will be evaluated in natural light using a mouth mirror, tweezers, cotton balls, and UNC -15 periodontal probe. At the screening visit, periodontal examination of all the eligible patients were carried out and impressions were made for fabrication of stent to ensure the reproducibility of measurements during the subsequent examinations. Occlusal stents for the repositioning of probe will be fabricated with self-cured acrylic resin on the study model of the patient to cover the occlusal as well as coronal one third of the buccal and lingual surfaces of the teeth involved. Vertical grooves were made to guide the probe penetration vertically in the same plane everytime it was inserted for recording the measurements. All the clinical parameters were recorded by a single examiner. The 40 subjects were divided into two groups. Group A - scaling and root planing followed by copper nanoparticles gel application in residual pockets, Group B - Scaling and root planing followed by chlorhexidine gel application in residual pockets using a blunt canula till the pocket is overfilled with the gel. The sites were covered with coe-pack to retain the material in the pocket as well as to prevent the ingress of oral fluids. The pack was removed after 7 days. 15 The clinical outcomes will be measured in terms of Papillary Bleeding Index (PBI) (by Saxer and Muhlemann 1975), Modified Plaque Index (MPI) (by Turesky et al modification of the Quigley-Hein Index1970), Probing Pocket Depth (PPD), Relative Attachment Level (RAL) at baseline, 1 month and 3 month. Patients were asked to maintain oral hygiene and no other chemical plaque control measures to use during the study period. Patients were asked to report immediately on developing any untoward reactions. Expected adverse effects were hypersensitivity and local reaction. At multiple points around the entire circumference of the tooth, probing pocket depth was measured in millimeters from the free gingival margin to the base of the sulcus. The floor of the sulcus was gently inspected horizontally using a periodontal probe. The UNC-15 probe was used to carefully measure the relative attachment level parallel to the long axis of the tooth until resistance was detected. The nearest millimeter was recorded from the bottom end of the occlusal stent as a reference point to the base of the pocket. Outcome : An examiner who has been calibrated will perform all the tests. In patients with periodontitis, the Papillary Bleeding Index (PBI), Modified Plaque Index (PI), Probing Pocket Depth (PPD), and Relative Attachment Level (RAL) were used to gauge both the primary and secondary results at baseline, one month, and three months. Statistical analysis The statistical computation and collation of all findings will be accomplished using SPSS software (version 26© SPSS, Chicago, IL). The means and standard deviations of the data will be calculated. When P<0.05, all clinical parameters (PBI, MPI, PPD, and CAL) will be considered statistically significant. Discussion The implementation of nanotechnology to enhance the delivery of medications for periodontal diseases has been validated by research conducted over the last ten years. Because nanoparticulates may encompass multifunctional elements, alter drug release kinetics, are target-specific, and respond to an array of external signaling sources, they present a unique potential in treating periodontal diseases. The application of nanotechnology in drug delivery has been demonstrated to be rapid and effective. To advance nanotechnology-assisted drug delivery from basic research to clinical practice, a number of issues need to be resolved. Partnering experts from multiple disciplines is essential for turning breakthrough laboratory findings into therapeutic products that might be sold successfully. 16 – 18 Study status Ongoing. Ethics and consent The Subjects will come from the Department of Periodontology and Implantology at Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences, Sawangi, Wardha. The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Ethics Committee (IEC) (DMMIMS (DU)/IEC/2021/581) on 1/10/2021. The Central Ethics Committee on Human Research (C.E.C.H.R) ethical standards were followed for medical research involving human subjects. This Randomized Control Clinical Trial is registered under Clinical Trial Registry of India ( www.ctri.nic.in ) (CTRI/2022/07/044047). The patients were willing to provide written informed consent and cooperate with the protocol. 19 The primary investigator will obtain informed consent for this prospective study. Data availability No data are associated with this article. References 1. Saafan A, Zaazou MH, Sallam MK, et al. : Assessment of Photodynamic Therapy and Nanoparticles Effects on Caries Models. Open Access Maced. J. Med. Sci. 2018 Jul 12; 6 (7): 1289–1295. PubMed Abstract | Publisher Full Text | Free Full Text Reference Source 2. Saafan A, Zaazou MH, Sallam MK, et al. : Assessment of Photodynamic Therapy and Nanoparticles Effects on Caries Models. Open Access Maced. J. Med. Sci. 2018 Jul 12; 6 (7): 1289–1295. PubMed Abstract | Publisher Full Text | Free Full Text Reference Source 3. Kornman KS: Mapping the pathogenesis of periodontitis: a new look. J. Periodontol. 2008 Aug; 79 (8 Suppl): 1560–1568. PubMed Abstract | Publisher Full Text Reference Source 4. Gutiérrez MF, Malaquias P, Matos TP, et al. : Mechanical and microbiological properties and drug release modeling of an etch-and-rinse adhesive containing copper nanoparticles. Dent. Mater. 2017; 33 (3): 309–320. 0109-5641. PubMed Abstract | Publisher Full Text Reference Source 5. Al Hulami H, Babay N, Awartani F, et al. : The effect of locally delivered doxycycline as an adjunctive therapy to scaling and root planing in smokers. Saudi Dent. J. 2011 Jul; 23 (3): 143–8. Epub 2011 May 3. PubMed Abstract | Publisher Full Text | Free Full Text Reference Source 6. Tan OL, Safii SH, Razali M: Commercial Local Pharmacotherapeutics and Adjunctive Agents for Nonsurgical Treatment of Periodontitis: A Contemporary Review of Clinical Efficacies and Challenges. Antibiotics (Basel). 2019 Dec 30; 9 (1): 11. PubMed Abstract | Publisher Full Text | Free Full Text Reference Source 7. Weaver L, Noyce JO, Michels HT, et al. : Potential action of copper surfaces on meticillin-resistant Staphylococcus aureus. J. Appl. Microbiol. 2010 Dec; 109 (6): 2200–2205. PubMed Abstract | Publisher Full Text Reference Source 8. Bezza FA, Tichapondwa SM, Chirwa EMN: Fabrication of monodispersed copper oxide nanoparticles with potential application as antimicrobial agents. Sci. Rep. 2020 Oct 7; 10 (1): 16680. PubMed Abstract | Publisher Full Text | Free Full Text Reference Source 9. Mombelli A: Microbial colonization of the periodontal pocket and its significance for periodontal therapy. Periodontol. 2018 Feb; 76 (1): 85–96. PubMed Abstract | Publisher Full Text Reference Source 10. Godoy-Gallardo M, Eckhard U, Delgado LM, et al. : Antibacterial approaches in tissue engineering using metal ions and nanoparticles: From mechanisms to applications. Bioact Mater. 2021 May 8; 6 (12): 4470–4490. PubMed Abstract | Publisher Full Text | Free Full Text Reference Source 11. Wang L, Hu C, Shao L: The antimicrobial activity of nanoparticles: present situation and prospects for the future. Int. J. Nanomedicine. 2017 Feb 14; 12 : 1227–1249. PubMed Abstract | Publisher Full Text | Free Full Text Reference Source 12. Allaker RP: The Use of Antimicrobial Nanoparticles to Control Oral Infections. Nano-Antimicrobials. 2011 Aug 26; 395–425. Publisher Full Text | Free Full Text Reference Source 13. Dr. Mahale S , Dr. Dhadse P , Dr. Mahale A , et al. : In vitro assessment of copper nanoparticle gel as a futuristic drug delivery agent against periodontal pathogens. PREPRINT (Version 1) available at Research Square. 11 July 2023. Reference Source 14. Spirit Checklist for Evaluation of clinical efficacy of scaling and root planing with copper nanoparticles gel and/or chlorhexidine gel in patients with periodontitis – A Randomized Control Trial. DOI: 10.6084/m9.figshare.25479196. http 15. Lindhe J: Chlorhexidine. Clinical periodontology and implant dentistry 5 th edition.748–751. Reference Source 16. Sharmin S, Rahaman MM, Sarkar C, et al. : Nanoparticles as antimicrobial and antiviral agents: A literature-based perspective study. Heliyon. 2021 Mar 13; 7 (3): e06456. PubMed Abstract | Publisher Full Text | Free Full Text Reference Source 17. Toodehzaeim MH, Zandi H, Meshkani H, et al. : The Effect of CuO Nanoparticles on Antimicrobial Effects and Shear Bond Strength of Orthodontic Adhesives. J. Dent (Shiraz). 2018 Mar; 19 (1): 1–5. PubMed Abstract | Free Full Text Reference Source 18. Ahmed SB, Mohamed HI, Al-Subaie AM, et al. : Investigation of the antimicrobial activity and hematological pattern of nano-chitosan and its nano-copper composite. Sci. Rep. 2021 May 5; 11 (1): 9540. PubMed Abstract | Publisher Full Text | Free Full Text Reference Source 19. Informed_Consent_for_Study_protocol Evaluation_of_clinical_efficacy_of_scaling_and_root_planing_with_copper_nanoparticles_gel_and_or_chlorhexidine_gel_in_patients_with_periodontitis/25498501. http Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 23 Apr 2024 ADD YOUR COMMENT Comment Author details Author details 1 Periodontology, Sharad Pawar Dental College, DMIHER, Wardha/Sawangi, India 2 Periodontology, Sharad Pawar Dental College, DMIHER, Wardha,Sawangi, India Swapna Mahale Roles: Conceptualization, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing Prasad Dhadse Roles: Formal Analysis, Project Administration, Supervision, Validation, Visualization, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 23 Apr 2024, 13:315 https://doi.org/10.12688/f1000research.148859.1 Copyright © 2024 Mahale S and Dhadse P. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Mahale S and Dhadse P. Evaluation of clinical efficacy of scaling and root planing with copper nanoparticles gel and/or chlorhexidine gel in patients with periodontitis: A randomized control trial [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :315 ( https://doi.org/10.12688/f1000research.148859.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 23 Apr 2024 Views 0 Cite How to cite this report: Isola G. Reviewer Report For: Evaluation of clinical efficacy of scaling and root planing with copper nanoparticles gel and/or chlorhexidine gel in patients with periodontitis: A randomized control trial [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :315 ( https://doi.org/10.5256/f1000research.163230.r397492 ) The direct URL for this report is: https://f1000research.com/articles/13-315/v1#referee-response-397492 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 14 Aug 2025 Gaetano Isola , University of Catania, Catania, Italy Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.163230.r397492 In the manuscript entitled: “Evaluation of clinical efficacy of scaling and root planing with copper nanoparticles gel and/or chlorhexidine gel in patients with periodontitis: A randomized control trial" the author aimed to assess the clinical outcomes of a local drug ... Continue reading READ ALL In the manuscript entitled: “Evaluation of clinical efficacy of scaling and root planing with copper nanoparticles gel and/or chlorhexidine gel in patients with periodontitis: A randomized control trial" the author aimed to assess the clinical outcomes of a local drug delivery agent (copper nanoparticle gel against chlorhexidine gel) with scaling and root planing in patients with periodontitis. The author found that Because copper fittings and work surfaces are capable of eliminating methicillin-resistant S. aureus (MRSA) to prevent cross-contamination, they act as an additional obstacle. Additional research is needed, as the mode of action of nanoparticles is not fully understood. Existing information concerning NPs encourages further research to explore their use in the control of dental infections. Major comments: In general, the idea and innovation of this study regards the analysis of the link between periodontitis and treatment is interesting and novel because the role these aspects in medicine are validated but further studies on this topic could be an innovative issue in this field could be open a creative matter of debate in literature by adding new information. Moreover, there are few reports in the literature that studied this interesting topic with this kind of study design. The study was well conducted by the authors; However, there are some concerns to revise that are described below. The introduction section resumes the existing knowledge regarding the important factor linked with the relationship between periodontitis and related mediators. However, as the importance of the topic, the reviewer strongly recommends, before a further re-evaluation of the manuscript, to update the literature through read, discuss and cites in the references with great attention all of those recent interesting articles, that helps the authors to better introduce and discuss the relationship and impact of chlorexidine and systemic health on oral and periodontal tissues mediators: Ref 1 and 2 The authors should be better specified, at the end of the introduction section, the rationale of the study and the aim of the study. In the central section, should better clarify inclusions and exclusions criteria of the selected sample. Please better state the results obtained in the abstract. The discussion section appears well organized with the relevant paper that support the conclusions, even if the authors should better discuss the relationship regarding the by periodontitis in and risk of oxidative stress evolution linked with inflammation. The conclusion should reinforce in light of the discussions. In conclusion, I am sure that the authors are fine clinicians who achieve very nice results with their adopted protocol. However, this study, in my view does not in its current form satisfy a very high scientific requirement for acceptance and requests a revision before a further re-evaluation of the manuscript. Minor Comments: Abstract: Better formulate the abstract section by better describing the aim of the study Introduction: Please refer to major comments Discussion Please add a specific sentence that clarifies the results obtained in the first part of the discussion Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Partly Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Yes References 1. Isola G, Polizzi A, Santagati M, Alibrandi A, et al.: Effect of Nonsurgical Mechanical Debridement With or Without Chlorhexidine Formulations in the Treatment of Peri‐Implant Mucositis. A Randomized Placebo‐Controlled Clinical Trial. Clinical Oral Implants Research . 2025; 36 (5): 566-577 Publisher Full Text 2. Isola G, Polizzi A, Serra S, Boato M, et al.: Relationship between periodontitis and systemic diseases: A bibliometric and visual study. Periodontology 2000 . 2025. Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: periodontology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Isola G. Reviewer Report For: Evaluation of clinical efficacy of scaling and root planing with copper nanoparticles gel and/or chlorhexidine gel in patients with periodontitis: A randomized control trial [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :315 ( https://doi.org/10.5256/f1000research.163230.r397492 ) The direct URL for this report is: https://f1000research.com/articles/13-315/v1#referee-response-397492 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 23 Apr 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 23 Apr 24 read Gaetano Isola , University of Catania, Catania, Italy Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Isola G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 14 Aug 2025 | for Version 1 Gaetano Isola , University of Catania, Catania, Italy 0 Views copyright © 2025 Isola G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions In the manuscript entitled: “Evaluation of clinical efficacy of scaling and root planing with copper nanoparticles gel and/or chlorhexidine gel in patients with periodontitis: A randomized control trial" the author aimed to assess the clinical outcomes of a local drug delivery agent (copper nanoparticle gel against chlorhexidine gel) with scaling and root planing in patients with periodontitis. The author found that Because copper fittings and work surfaces are capable of eliminating methicillin-resistant S. aureus (MRSA) to prevent cross-contamination, they act as an additional obstacle. Additional research is needed, as the mode of action of nanoparticles is not fully understood. Existing information concerning NPs encourages further research to explore their use in the control of dental infections. Major comments: In general, the idea and innovation of this study regards the analysis of the link between periodontitis and treatment is interesting and novel because the role these aspects in medicine are validated but further studies on this topic could be an innovative issue in this field could be open a creative matter of debate in literature by adding new information. Moreover, there are few reports in the literature that studied this interesting topic with this kind of study design. The study was well conducted by the authors; However, there are some concerns to revise that are described below. The introduction section resumes the existing knowledge regarding the important factor linked with the relationship between periodontitis and related mediators. However, as the importance of the topic, the reviewer strongly recommends, before a further re-evaluation of the manuscript, to update the literature through read, discuss and cites in the references with great attention all of those recent interesting articles, that helps the authors to better introduce and discuss the relationship and impact of chlorexidine and systemic health on oral and periodontal tissues mediators: Ref 1 and 2 The authors should be better specified, at the end of the introduction section, the rationale of the study and the aim of the study. In the central section, should better clarify inclusions and exclusions criteria of the selected sample. Please better state the results obtained in the abstract. The discussion section appears well organized with the relevant paper that support the conclusions, even if the authors should better discuss the relationship regarding the by periodontitis in and risk of oxidative stress evolution linked with inflammation. The conclusion should reinforce in light of the discussions. In conclusion, I am sure that the authors are fine clinicians who achieve very nice results with their adopted protocol. However, this study, in my view does not in its current form satisfy a very high scientific requirement for acceptance and requests a revision before a further re-evaluation of the manuscript. Minor Comments: Abstract: Better formulate the abstract section by better describing the aim of the study Introduction: Please refer to major comments Discussion Please add a specific sentence that clarifies the results obtained in the first part of the discussion Is the rationale for, and objectives of, the study clearly described? Partly Is the study design appropriate for the research question? Partly Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Yes References 1. Isola G, Polizzi A, Santagati M, Alibrandi A, et al.: Effect of Nonsurgical Mechanical Debridement With or Without Chlorhexidine Formulations in the Treatment of Peri‐Implant Mucositis. A Randomized Placebo‐Controlled Clinical Trial. Clinical Oral Implants Research . 2025; 36 (5): 566-577 Publisher Full Text 2. Isola G, Polizzi A, Serra S, Boato M, et al.: Relationship between periodontitis and systemic diseases: A bibliometric and visual study. Periodontology 2000 . 2025. Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise periodontology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Isola G. Peer Review Report For: Evaluation of clinical efficacy of scaling and root planing with copper nanoparticles gel and/or chlorhexidine gel in patients with periodontitis: A randomized control trial [version 1; peer review: 1 approved with reservations] . F1000Research 2024, 13 :315 ( https://doi.org/10.5256/f1000research.163230.r397492) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-315/v1#referee-response-397492 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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