A Local Desiccant Antimicrobial Agent as an Alternative to Adjunctive Antibiotics in the Treatment of Periodontitis: A Narrative Review

Abstract

Periodontitis is one of the most common oral polymicrobial infectious diseases induced by the complex interplay between the altered subgingival microbiota and the host’s dysregulated immune-inflammatory response, leading to the initiation of progressive and irreversible destruction of the periodontal tissues and eventually to tooth loss. The main goal of cause-related periodontal therapy is to eliminate the dysbiotic subgingival biofilm in order to arrest local inflammation and further periodontal tissue breakdown. Because, in some cases, subgingival mechanical instrumentation has limited efficiency in achieving those goals, various adjunctive therapies, mainly systemic and locally delivered antimicrobials, have been proposed to augment its effectiveness. However, most adjunctive antimicrobials carry side effects; therefore, their administration should be precociously considered. HybenX® (HY) is a commercial therapeutical agent with decontamination properties, which has been studied for its effects in treating various oral pathological conditions, including periodontitis. This review covers the current evidence regarding the treatment outcomes and limitations of conventional periodontal therapies and provides information based on the available experimental and clinical studies related to the HY mechanism of action and effects following its use associated with subgingival instrumentation and other types of dental treatments.

The Treatment of Severe Periodontitis Using a Local Antiseptic Desiccant and Subgingival Mechanical Instrumentation: A Pilot Study

“…A significantly increased penetration of the cleaning depth was observed in those teeth receiving the combined therapy (4.41 ± 2.96 mm) as opposed to teeth receiving a single therapy (2.67 ± 2.70 mm). These results indicate that HY does not facilitate the calculus detachment from the treated root surfaces but only plaque disruption [ 18 ]. Thus, this product containing sulphonic/sulphuric acids can favor the active detachment of biofilms from the infected subgingival areas through its rapid desiccation capacity facilitating the removal of the biofilm using mechanical instruments [ 22 , 24 ].…”

“…HY was selected in our study due to the serious concerns related to the increased bacterial resistance associated with systemic antibiotic therapy, which indicates the need for collective efforts to identify alternative adjunctive products that can enhance the antimicrobial effect of subgingival instrumentation [ 22 , 44 ]. However, HY has received less attention in research, and its mechanism of action remains unclear [ 18 ].…”

“…A commercial antimicrobial and desiccant product containing sulphonic/sulphuric acids, HYBENX ® (HY), Epien Medical, St. Paul, MN, USA [ 16 ], initially used to protect oral ulcerative lesions [ 17 ], has been recently recommended as a potential adjunctive drug to treat periodontitis and peri-implantitis lesions. However, there is scarce information on its clinical efficacy or action in periodontitis therapy [ 18 ]. HY has desiccation and cauterization effects and can denature and coagulate tissue debris, forming a protective coating over ulcerated areas [ 17 , 19 , 20 ].…”

Evaluation of the Microbial Profile on the Polydioxanone Membrane and the Collagen Membrane Exposed to Multi-Species Subgingival Biofilm: An In Vitro Study

“…Furthermore, the metabolic by-products stemming from its peptidoglycan breakdown have been flagged for their propensity to destabilize host immune responses, thereby facilitating a dysbiotic subgingival biofilm milieu. Such a landscape of pathogenic microbiota kindles an inflamed reaction, culminating in the sequential degradation of supporting periodontal structures, leading to increased clinical attachment losses and, in grave cases, total tooth loss [2,28].…”

“…Among oral afflictions, periodontitis stands out for its high prevalence and associated complications [1]. Originating from a dysbiotic dental biofilm, this pathology is the outcome of the intricate interaction between the host and a vast bacterial community that predominantly establishes itself in subgingival regions, leading to the progressive destruction of dental support tissues [2,3].…”