Journal of trace elements in medicine and biology : organ of the Society for Minerals and Trace Elements (GMS) · 2026
Zinc-integrated strategies in active periodontal therapy: Mapping the evidence to the EFP stepwise framework - A scoping review (2020-2025).
СтатьяScoping ReviewНазвание и аннотация: Перевод в очереди
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Sikder Farhana, Vaithilingam Rathna Devi, Rahman Mohammad Tariqur, Aziz Jazli
Аннотация
BACKGROUND: Periodontitis is a significant global health burden, requiring effective management strategies to prevent tooth loss. The European Federation of Periodontology (EFP) S3-level clinical practice guidelines (2020) advocate a comprehensive, stepwise therapeutic approach to periodontal therapy, emphasizing the need for effective adjunctive regenerative modalities to limit the disease progression. Zinc, a trace element with well-established anti-inflammatory, antimicrobial and regenerative properties, has drawn significant attention in this domain. However, its diverse applications across the modern therapeutic protocols remain unmapped.
OBJECTIVE: The primary objective of this review was to map the available evidence regarding zinc-integrated therapeutic strategies within active periodontal therapy and evaluate their alignment with the first three steps of EFP framework over the last five years.
INCLUSION CRITERIA: The review considered human clinical trials and in vivo animal studies including the biological validation phases of hybrid biomaterial research, published between January 2020 and December 2025 that evaluated zinc-integrated interventions for periodontal or alveolar bone defects.
METHODS: This scoping review followed the methodology of the Joanna Briggs Institute. A systematic search was executed across PubMed, Scopus, and Web of Science using a consolidated keyword strategy. Study selection, data extraction and evidence grading, using Oxford Centre for Evidence-Based Medicine 2009 levels of Evidence were performed to map study characteristics, zinc formulations, and clinical outcomes against the EFP framework.
RESULTS: A total of 1239 records were identified, with 68 studies included in the final synthesis. Evidence for Step 1 and conventional Step 2 was primarily derived from clinical trials (Level 1b) evaluating zinc containing oral hygiene products and local delivery agents, demonstrating significant potential in biofilm and gingival inflammation reduction. Conversely, most Step 2 smart nanomaterials and Step 3 surgical regeneration evidence remained confined to preclinical animal models (Level 5).
CONCLUSION: Zinc interventions offer potential, stage-specific benefits across EFP framework. Although early-phase biofilm control is effectively managed by zinc-driven ecological modulation, more invasive subgingival and surgical applications currently lack longitudinal human validation. While preclinical scaffolds exhibit profound osteoimmunomodulatory capabilities, clinical translation is fundamentally bottlenecked by element's dose-dependent cytotoxicity. Simultaneously, preclinical development should consider transitioning from conventional zinc-containing additives toward true zinc-based structural alloys. Ultimately, advancing these innovations into long-term clinical trials alongside rigorous multi-omic safety monitoring is necessary to fully realise zinc's potential as a key component in periodontal therapy.
OBJECTIVE: The primary objective of this review was to map the available evidence regarding zinc-integrated therapeutic strategies within active periodontal therapy and evaluate their alignment with the first three steps of EFP framework over the last five years.
INCLUSION CRITERIA: The review considered human clinical trials and in vivo animal studies including the biological validation phases of hybrid biomaterial research, published between January 2020 and December 2025 that evaluated zinc-integrated interventions for periodontal or alveolar bone defects.
METHODS: This scoping review followed the methodology of the Joanna Briggs Institute. A systematic search was executed across PubMed, Scopus, and Web of Science using a consolidated keyword strategy. Study selection, data extraction and evidence grading, using Oxford Centre for Evidence-Based Medicine 2009 levels of Evidence were performed to map study characteristics, zinc formulations, and clinical outcomes against the EFP framework.
RESULTS: A total of 1239 records were identified, with 68 studies included in the final synthesis. Evidence for Step 1 and conventional Step 2 was primarily derived from clinical trials (Level 1b) evaluating zinc containing oral hygiene products and local delivery agents, demonstrating significant potential in biofilm and gingival inflammation reduction. Conversely, most Step 2 smart nanomaterials and Step 3 surgical regeneration evidence remained confined to preclinical animal models (Level 5).
CONCLUSION: Zinc interventions offer potential, stage-specific benefits across EFP framework. Although early-phase biofilm control is effectively managed by zinc-driven ecological modulation, more invasive subgingival and surgical applications currently lack longitudinal human validation. While preclinical scaffolds exhibit profound osteoimmunomodulatory capabilities, clinical translation is fundamentally bottlenecked by element's dose-dependent cytotoxicity. Simultaneously, preclinical development should consider transitioning from conventional zinc-containing additives toward true zinc-based structural alloys. Ultimately, advancing these innovations into long-term clinical trials alongside rigorous multi-omic safety monitoring is necessary to fully realise zinc's potential as a key component in periodontal therapy.