Phyto-nanotechnology for biofilm-associated periodontitis: Quantitative evidence and translational roadmap from laboratory to clinic

Periodontal disease affects >50% of adults globally, yet current therapies fail due to antimicrobial resistance and inadequate biofilm penetration in deep pockets (>6 mm). Despite two decades of nanotechnology research yielding 50+ approved nanomedicines, no phyto-nanotechnology product has achieved regulatory approval for periodontal therapy, representing a critical translational gap that this review systematically addresses. This PRISMA 2020-compliant systematic review analyzed 32 studies (in vitro: 53.13%; animal: 34.38%; clinical: 12.5%) to establish the first comprehensive quantitative benchmarks for phyto-nanoformulations: 6.2–18.4-fold MIC reductions and 2.8–4.6-fold enhanced biofilm penetration versus conventional preparations. Nano-propolis demonstrated 10× superior antimicrobial potency with unprecedented biofilm penetration (180–240 μm vs. 40–65 μm). Curcumin nanocrystals achieved 47–127-fold solubility enhancement and 32–64-fold MIC reduction. Uniquely, naringin nanoparticles activated osteogenic pathways (BMP2/Runx2/Osterix), positioning phyto-nanotechnology as a disease-modifying rather than merely antimicrobial therapy. This review is the first to integrate antimicrobial, immunomodulatory, and osteogenic dimensions while providing an evidence-based translational roadmap from bench to bedside. We systematically identify barriers preventing clinical translation: pharmaceutical-grade manufacturing challenges, regulatory pathway ambiguities, and economic sustainability questions. Our translational framework provides actionable guidance for researchers, regulatory scientists, and pharmaceutical developers to advance phyto-nanotechnology from promising laboratory findings to economically viable clinical solutions for 3.5 billion patients worldwide suffering from periodontal disease.