Influence of Reactive Oxygen Species on Wound Healing and Tissue Regeneration in Periodontal and Peri-Implant Tissues in Diabetic Patients

Abstract

Diabetes mellitus (DM) is associated with periodontal disease. Clinically, periodontal treatment is less effective for patients with DM. Oxidative stress is one of the mechanisms that link DM to periodontitis. The production of reactive oxygen species (ROS) is increased in the periodontal tissues of patients with DM and is involved in the development of insulin resistance in periodontal tissues. Insulin resistance decreases Akt activation and inhibits cell proliferation and angiogenesis. This results in the deterioration of wound healing and tissue repair in periodontal tissues. Antioxidants and insulin resistance ameliorants may inhibit ROS production and improve wound healing, which is worsened by DM. This manuscript provides a comprehensive review of the most recent basic and clinical evidence regarding the generation of ROS in periodontal tissues resulting from microbial challenge and DM. This study also delves into the impact of oxidative stress on wound healing in the context of periodontal and dental implant therapies. Furthermore, it discusses the potential benefits of administering antioxidants and anti-insulin resistance medications, which have been shown to counteract ROS production and inflammation. This approach may potentially enhance wound healing, especially in cases exacerbated by hyperglycemic conditions.

Short- and long-term exposure to high glucose induces unique transcriptional changes in osteoblasts in vitro

“…Hyperglycemia and mitochondrial dysfunction increase the accumulation of intracellular ROS, which contribute to inflammation and impairment of various cellular processes causing DNA damage, cellular senescence, and apoptosis ( Kang et al, 2015 ; Morgan and Liu, 2010 ; Rharass and Lucas, 2019 ). Accumulation of ROS may be one of the mechanisms responsible for cellular defects and complications related to diabetes, such as retinopathy ( Chan et al, 2020 ) and impaired wound healing ( Buranasin et al, 2023 ). Interestingly, increased intracellular ROS production in response to high-glucose environment has been reported to occur also in bone cells ( Zeng et al, 2021 ; Zhen et al, 2010 ), suggesting that ROS might contribute to bone-related complications of T2DM.…”

Innovative Bio‐based Hydrogel Microspheres Micro‐Cage for Neutrophil Extracellular Traps Scavenging in Diabetic Wound Healing

“…This oxidative stress not only compromises skin cell survival but also induces a pro-inflammatory macrophage phenotype, sustaining a chronic pro-inflammatory environment and impeding the natural wound healing process. [24] Recognizing the significance of addressing oxidative stress in diabetic wound management, ROS scavenging strategies have emerged as promising treatments, with PDA standing out as a noteworthy candidate. [25] PDA, rich in reducing groups like phenol and catechol, exhibits excellent redox capacity and serves as an effective ROS scavenger by donating free radical electrons.…”

Management of Advanced Peri-Implantitis by Guided Bone Regeneration in Combination with Trabecular Metal Fixtures, Two Months after Removal of the Failed Implants: Two-Year Results of a Single-Cohort Clinical Study

“…Peri-implantitis occurs primarily as a result of an overwhelming bacterial challenge and subsequent uncontrolled host immune response [4,5]. According to the recent literature, a key role for the onset and progression of peri-implantitis can be ascribed to the oxidative stress due to diabetes mellitus [6] and other unfavorable local and systemic metabolic conditions causing an inflammatory burden [7], in association with a polymicrobial infection that may affect peri-implant bone and soft tissues [8]. Also, like periodontitis, a greater risk of developing peri-implantitis as well as worse outcomes of both surgical and nonsurgical treatment have been observed in tobacco smokers, as compared to non-smokers [9].…”