Mapping the landscape of antimicrobial peptides in periodontology: A scoping review

Antimicrobial peptides (AMPs) are gaining attention as adjunctive agents in periodontal therapy due to their antimicrobial, anti-inflammatory, and host-modulatory properties. Their potential adjunctive applications include use as local drug delivery agents, topical pastes, gels or mouthrinses, reinforcements of membranes or implant surfaces, and other applications. While numerous in vitro and animal studies have investigated their utility, the evidence remains scattered, with no comprehensive synthesis available.

This scoping review aimed to map the existing available evidence on AMPs in periodontal therapy, focusing on AMP types, delivery systems, and reported biological, microbiological, and clinical outcomes.

A systematic literature search was conducted across Medline-PubMed, Cochrane, and Google Scholar for studies published in the past 20 years. Studies were included if they evaluated AMPs for periodontal therapy in vivo or in vitro. The key data extracted included the type of AMP, study model, outcomes, and conclusions. The review followed PRISMA-ScR guidelines.

A total of 21 studies were included, comprising 13 in vitro studies, 5 animal studies, and 3 clinical studies. The commonly investigated AMP was LL-37. Delivery systems ranged from gels, spays, nanoparticles, and conjugates. Included studies reported significant antimicrobial activity against various periodontal pathogens. Preclinical models and clinical models showed enhanced healing and tissue regeneration. However, variability in experimental design, AMP concentrations, and outcome measures limits comparability across various designs.

The existing literature proves AMPs to be a promising therapeutic adjunct in periodontal applications. Clinical data, however, are lacking. Bridging the gap between experimental findings and clinical application requires robust translational research, including well-designed human trials, to evaluate safety, efficacy, and long-term outcomes. This scoping review serves as a foundational reference for guiding future studies toward the clinical integration of AMPs in periodontal therapy.