Tiny Titans: Silver Nanoparticles Incorporated with Coe-Pak: A Clinical Study

International Journal of Dental Science and Innovative Research (IJDSIR) IJDSIR : Dental Publication Service Available Online at:www.ijdsir.com Volume – 8, Issue – 4, August – 2025, Page No. : 150 - 156 Corresponding Author: Dr. Anup Pantawane, ijdsir, Volume – 8 Issue - 4, Page No. : 150 - 156 Page150 ISSN: 2581-5989 PubMed - National Library of Medicine - ID: 101738774 Tiny Titans: Silver Nanoparticles Incorporated with Coe-Pak: A Clinical Study 1Dr. Anup Pantawane, Post-Graduate Student, Department of Periodontology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra. 1Dr. Rutuja Dani, Post-Graduate Student, Department of Periodontology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra. 1Dr. Sakshi Raut, Post-Graduate Student, Department of Periodontology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra. 2Dr. Grishmi Niswade, Reader and PG Guide, Department of Periodontology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra. 3Dr. Kamlesh Singh, Professor, Department of Periodontology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra. Corresponding Author: Dr. Anup Pantawane, Post-Graduate Student, Department of Periodontology, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra. Citation of this Article: Dr. Anup Pantawane, Dr. Rutuja Dani, Dr. Sakshi Raut, Dr. Grishmi Niswade, Dr. Kamlesh Singh, “Tiny Titans: Silver Nanoparticles Incorporated with Coe-Pak: A Clinical Study”, IJDSIRAugust – 2025, Volume – 8, Issue – 4, P. No. 150 – 156. Copyright: © 2025, Dr. Anup Pantawane, et al. This is an open access journal and article distributed under the terms of the creative common’s attribution non-commercial License. Which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given, and the new creations are licensed under the identical terms. Type of Publication: Original Research Article Conflicts of Interest: Nil Abstract Introduction: Coe-Pak is the most commonly used periodontal dressing in clinical practice. Silver nanoparticles is shown to have antibacterial properties and provide faster and effective tissue repair. To the best of our knowledge currently no periodontal dressing incorporating silver nanoparticles is available. Objectives: To compare and evaluate post-surgical wound healing using Coe-Pak and Coe-Pak with silver nanoparticles respectively in chronic periodontitis patients. Methodology: 20 systemically healthy patients requiring periodontal flap surgery were randomly divided into test (Coe-Pak with silver nanoparticles) and control (Coe-Pak alone) group. Post-surgical pain and wound healing were evaluated using visual analogue scale (on 3rd and 7th day), wound healing index on 7th day and modified gingival index at baseline and 7th day respectively. Results: Study revealed statistically significant outcomes, indicating that Coe-Pak with silver nanoparticles shows effective post-surgical wound Dr. Anup Pantawane, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page151 Page151 Page151 Page151 Page151 Page151 Page151 Page151 Page151 Page151 Page151 Page151 Page151 Page151 Page151 Page151 Page151 Page151 Page151 healing after periodontal flap surgery in chronic periodontitis patients. Conclusion: Coe-Pak with silver nanoparticles exhibits a potential role in effectively controlling post-surgical infections and allows better wound healing. Keyword: Coe-Pak, silver nanoparticles, periodontal dressing, wound healing. Introduction Chronic periodontitis is an inflammatory disease that results in significant destruction of the soft tissues and, eventually, the supporting bone structures around the teeth1. While mechanical plaque control methods can help maintain acceptable oral hygiene, they often fall short in effectively reducing inflammation and fully eliminating plaque. As a result, there is growing interest in incorporating antimicrobial agents as adjuncts to conventional therapy2. The primary microbial pathogens associated with periodontitis include Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Tannerella forsythia, Fusobacterium nucleatum, and Treponema denticola2. Periodontal dressing was first introduced by Ward in 1923, recommended its use following periodontal surgery3. At present, periodontal dressings are extensively used for various purposes; however, their use following periodontal surgery is a matter of debate4. Several advantages have been described for periodontal dressings recommending their application following periodontal surgery including wound protection from mechanical trauma, wound stabilization5,6, patient comfort, favourable adaptation to the underlying tissue, prevention of post-surgical bleeding or infection, decreased tooth hypersensitivity, clot protection from the loads applied during mastication and speech, prevention of gingival separation from the root7, prevent coronal displacement of an apically repositioned flap and to offer additional support for free gingival grafts during the healing phase 8. In general, periodontal dressings are divided into 3 groups: (a)Dressings containing zinc oxide eugenol (Ward’s Wondr Pak). (b)Dressings containing zinc oxide without eugenol (Periocare, Coe-Pak, VacPac, Septo-Pac). (c)Dressings without zinc oxide and eugenol (cellulose-based dressings i.e. Mucotect and Reso-Pac) and light-cured resin-based dressings (i.e. Barricaid). Coe-Pak is a widely utilized periodontal dressing in clinical practice. It comprises a two-paste system that includes base paste (zinc oxide, added oils, gums & lorothidol) and catalyst paste (unsaturated fatty acids & chlorothymol)9. The dressing is prepared by dispensing equal amounts of the two pastes and mixing them with a spatula until a thick, uniform consistency is achieved. The setting time can be modified by placing the material in cold water to slow down or in hot water to speed up the setting process. It offers protection and promotes healing, is easy to shape, eugenol-free, and compatible with both resin materials and soft tissues10. Silver (Ag) ions possess strong antibacterial properties and have been utilized in medical treatments for many years. Their low toxicity, excellent biocompatibility with human cells, and the continuous release of mobile silver ions contribute to a sustained and effective bactericidal effect11. Silver nanoparticles (AgNPs) measuring less than 100 nm and exhibiting a uniform spherical shape possess strong and broad-spectrum antimicrobial properties 12. The antibacterial mechanisms of silver nanoparticles (AgNPs) include, but are not limited to, the release of silver ions that can disrupt cell walls and membranes, denature ribosomes, interfere with ATP production, and hinder DNA replication13,14. Beyond the common roles of antibacterial, antifungal, and drug carriers, AgNPs have been observed to enhance human Dr. Anup Pantawane, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page152 Page152 Page152 Page152 Page152 Page152 Page152 Page152 Page152 Page152 Page152 Page152 Page152 Page152 Page152 Page152 Page152 Page152 Page152 periodontal ligament fibroblasts (HPDLFs) osteogenic differentiation in a dose-responsive way at the concentration range of 25–100 μM15. Silver nanoparticles is shown to have antibacterial properties and provide faster and effective tissue repair. Hence, the aim of this study is to assess the post-surgical wound healing of silver nano particles with coe pak compared to coe pak alone. Materials and methods: This randomized controlled clinical trial included 20 patients aged between 18 and 40 years, who reported to the Outpatient Department of Periodontology at Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, India. The total sample of 20 patients was divided randomly into two groups. The study was conducted after obtaining written informed consent from all participants. Eligible subjects were those undergoing periodontal flap surgeries and crown lengthening procedures. A detailed medical history, clinical examination, and complete hemogram were obtained for each patient. Inclusion criteria comprised systemically healthy males and females aged 18– 40 years. Exclusion criteria included smokers, pregnant and lactating women, patients with periodontal disease, and individuals with systemic conditions known to affect healing and coagulation, such as diabetes, autoimmune diseases, and leukemia. Participants were randomly allocated into two groups:  Test Group (Group I): Patients who underwent periodontal surgery with suturing of the surgical site, followed by the application of a periodontal dressing made of Coe-Pak modified with silver nanoparticles.  Control Group (Group II): Patients who underwent periodontal surgery with suturing of the surgical site, followed by the application of standard Coe-Pak periodontal dressing (without silver nanoparticles). Following the surgical procedure, an equal amount of the Coe-Pak base and catalyst paste was used to cover teeth on both the buccal and lingual aspects. For the test group, 2 mg of silver nanoparticles was incorporated into the Coe-Pak dressing by mixing it with the base and catalyst paste on a glass slab during manipulation. Parameters such as post-operative pain score (VAS) was assessed at 3rd day and 7th day post-surgery, modified gingival Index and wound healing index were assessed at baseline and 7th day post-surgery. Statistical Analysis: The study results were reported using descriptive statistical methods (mean ± standard deviation). The test used to compare patients’ preferences in different degrees of pain, repair, and stages of periodontitis was Chi-square test. Statistical analysis was performed using SPSS 18, and the statistical significance was set at P < 0.05. Repeated measurements test was used to compare the severity of pain at different time intervals. Pocket probing depth > 5mm Sutures placed after flap surgery Silver nanoparticles + Coe-Pak Dr. Anup Pantawane, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page153 Page153 Page153 Page153 Page153 Page153 Page153 Page153 Page153 Page153 Page153 Page153 Page153 Page153 Page153 Page153 Page153 Page153 Page153 Coe-Pak with silver nano-particles placed Coe-Pak removal after 7 days After suture removal Figure 1: Silver-nano particles + Coe-Pak placement after Periodontal flap surgery and Coe-Pak removal after 7 days Result The present study included 11 females and 09 males with a mean age of 29.15 ± 4.53 years. There were statistically significant differences in clinical parameters (VAS, WHI, MGI) between the two groups. All the 20 patients reported on both the 3rd and 7th day post-operative after each surgery for pain parameter and on baseline and 7th day for WHI and GBI. Pain assessment (Table 1) presents the evaluation of pain severity in the studied patients based on the VAS in the study groups on days 3 and 7 after surgery. In the control group, the pain parameter on the 7th day after the surgery was significantly lower than the 3rd day by 0.8 units (P = 0.003). In the intervention group, the pain parameter on the 7th day after the intervention was significantly reduced by 0.5 units compared to the 3rd day (P = 0.001). In addition, the severity of pain in the studied patients was significantly lower in the intervention group than in the control group on the 3rd (P = 0.001) and 7th (P = 0.001) days after the intervention. Wound Healing Index (Table 2) presents the evaluation of wound healing status in the studied patients based on the WHI in the study groups on baseline and 7th day after surgery. In the control group, the WHI value on the 7th day increased significantly by 1.2 units compared to the baseline after surgery (P = 0.001). In the intervention group, the WHI value increased significantly by 1.0 units on the 7th day after the intervention (P = 0.001). In addition, WHI values were significantly higher in the intervention group than in the control group on the baseline (P = 0.001) and 7th (P = 0.001) days after the surgery. Modified Gingival Index (Table 3) presents the evaluation of gingival status in the studied patients based on the MGI in the study groups on baseline and 7th day after surgery. In the control group, the WHI value on the 7th day decreased significantly by 0.53 units compared to the baseline after surgery (P = 0.001). In the test group, the MGI value decreased significantly by 0.60 units on 7th day after the intervention (P = 0.001). In addition, MGI values were significantly higher in the intervention group than in the control group on the baseline (P = 0.001) and 7th (P = 0.001) days after the surgery. Dr. Anup Pantawane, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page154 Page154 Page154 Page154 Page154 Page154 Page154 Page154 Page154 Page154 Page154 Page154 Page154 Page154 Page154 Page154 Page154 Page154 Page154 Table 1: VAS (Visual Analogue Scale) Group Days post-operative Mean ± standard deviation Test group 3rd day 1.5±3.45 7th day 0.9±0.65 Control group 3rd day 2.2±2.45 7th day 1.4±0.35 Table 2: (WHI) Wound Healing Index Group Days post-operative Mean + standard deviation Test group Baseline 2.8±1.2 7th day 3.8±1.0 Control group Baseline 2.6±1.1 7th day 3.2±0.9 Table 3: (MGI) Modified Gingival Index Group Days post-operative Mean + standard deviation Test group Baseline 1.7±0.7 7th day 1.1±0.3 Control group Baseline 1.8±0.6 7th day 1.3±0.4 Discussion Periodontal dressings are intended to protect the wound after periodontal surgery to prevent any delay in the process of wound healing. The present study included 20 subjects with age group of 18-40 years. This study identifies that the AgNPs incorporated in Coe-Pak significantly accelerates the wound healing and other parameters. A study on Alginate-Based Materials Loaded with Nanoparticles in Wound Healing done by Froelich A, et al. (2023) concluded that integrating a hydrogel matrix with silver nanoparticles (AgNPs) offers considerable benefits for both promoting wound healing and providing antibacterial effects. While the physical, chemical, and biological characteristics of these engineered matrices and AgNPs have been well-researched and various applications have been identified, there are still important areas to explore—particularly the behavior of AgNPs at the cellular level in humans, as well as their local versus systemic toxicity.16. Kadkhodazadeh M. et al. (2017) reported that Reso-Pac, a cellulose-based periodontal dressing, demonstrates greater biocompatibility with human gingival fibroblast cells compared to Coe-Pak. In contrast, Coe-Pak exhibits notable cytotoxic effects on both human gingival fibroblasts and osteoblast-like cells, particularly after three days of application. Despite their intended benefits, certain periodontal dressings may hinder gingival wound healing post-surgery due to the release of harmful substances17. Singh M. et al. (2022) concluded that the strategic application and versatility of silver nanoparticles have introduced a new era of highly effective, multi-functional treatment options in the medical field. However, to fully harness their potential in tissue regeneration, further preclinical research is necessary. Additionally, producing Dr. Anup Pantawane, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page155 Page155 Page155 Page155 Page155 Page155 Page155 Page155 Page155 Page155 Page155 Page155 Page155 Page155 Page155 Page155 Page155 Page155 Page155 high-purity nanoparticles remains a significant challenge, as large-scale synthesis and purification of nanoparticles and associated polymers are often complex and inefficient. This underscores the ongoing need for the development of more advanced synthetic and analytical methods to facilitate the clinical translation of nanotechnology-based therapies18. Nasiri K et al. (2023) highlighted that metal nanoparticles are among the most promising antibacterial agents, owing to their high surface area-to-volume ratio, extended shelf life, and good biocompatibility. Their nanoscale size enables them to penetrate the biofilm matrix and establish direct contact with bacterial cells, thereby effectively disrupting and inhibiting biofilm formation.19. In a study by Moghare Abed et al (2011)20 similar pain was noted in patients with and without periodontal dressings after surgery, while in the study by Jones et al (1979)21 more pain was reported in patients following the use of periodontal dressings. Liao et al. (2010) reported that titanium implant surfaces coated with silver nanoparticles exhibited significantly enhanced antibacterial and anti-adhesive properties against Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis 22. In the current era of growing interest in nanotechnology, silver nanoparticles have emerged as promising agents for accelerating wound healing. In addition to their therapeutic role in combating infections, silver nanoparticles are considered non-toxic at appropriate concentrations, exhibit minimal to no side effects, and can be applied without the need for complex procedures or specialized equipment. Their ease of use, combined with high patient tolerance and acceptance, makes them an effective and practical option in clinical care23. Conclusion Based on the result it can be concluded that incorporating silver nanoparticles into Coe-Pak significantly enhances its effectiveness as a periodontal dressing. Alongside its protective barrier function, the added antimicrobial properties help prevent infections, reduce inflammation, and promote faster healing. This dual-action approach supports cleaner, safer, and more predictable recovery, making it a promising advancement in post-surgical oral care. References 1. Cochran DL. Inflammation and bone loss in periodontal disease. Journal of periodontology. 2008 Aug;79: 1569-1576. 2. Teles R, Teles F, Frias‐Lopez J, Paster B, Haffajee A. Lessons learned and unlearned in periodontal microbiology. Periodontology 2000. 2013 Jun;62 (1):95-162. 3. 1. Ward AW. Postoperative Care in the Surgical Treatment of Pyorrhea. J Am Dent Assoc. 1929 Apr 1;16(4):635-640. 4. 2. Kathariya R, Jain H, Jadhav T. To pack or not to pack: the current status of periodontal dressings. J Appl Biomater Funct Mater. 2015 Jul 4;13(2):73-86. 5. 3. Arnold A, Ariaudo BS, Howard A, Tyrrell BS. Repositioning and increasing the zone of attached gingiva. J Periodontol. 1957 ;28(2):106-110. 6. 4. Prichard JF. Present state of the interdental denudation procedure. J Periodontol. 1977 Sep;48 (9):566-569. 7. 5. Wikesjö UM, Nilvéus RE, Selvig KA. Significance of early healing events on periodontal repair: a review. J Periodontol. 1992 Mar;63(3):15865. [Medline: 1593409] [doi: 10.1902/ jop.1992. 63.3.158] Dr. Anup Pantawane, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page156 Page156 Page156 Page156 Page156 Page156 Page156 Page156 Page156 Page156 Page156 Page156 Page156 Page156 Page156 Page156 Page156 Page156 Page156 8. 6. Harpenan LA. Periodontal dressing. In: Hall WB, editors. Critical Decisions in Periodontology, 4th ed. Ontario: BC Decker; 2003. p. 280-281. 9. Sadighi M, Faramarzi M, Pourabbas R, Torab Z, Mohammadi H, Hoseein Nazmi S. Comparison of the effects of Diplen LX membrane and Coe-Pak on pain, wound healing, and patient preference after the periodontal flap surgery in patients with moderate to severe chronic periodontitis. J Dent Res Dent Clin Dent Prospects. 2022 Spring;16(2):135-139. 10. Bezawada NR, Bali S, Aggarwal P, Arora S. Periodontal dressings: A review. Santosh University Journal of Health Sciences. 2020;6(1):5-9. 11. Mitra D, Kang ET, Neoh KG. Polymer-based coatings with integrated antifouling and bactericidal properties for targeted biomedical applications. ACS Applied Polymer Materials. 2021 Apr 20;3(5):223363. 12. Singh M., Thakur, V.; Kumar, V.; Raj, M.; Gupta, S.; Devi, N.; Upadhyay, S.K.; Macho, M.; Banerjee, A.; Ewe, D.; et al. Silver Nanoparticles and Its Mechanistic Insight for Chronic Wound Healing: Review on Recent Progress. Molecules 2022, 27, 5587. 13. Oves M, Aslam M, Rauf MA, et al. Antimicrobial and anticancer activities of silver nanoparticles synthesized from the root hair extract of Phoenix dactylifera. Mater Sci Eng C Mater Bio Appl. 2018; 89:429–443. 14. Yin IX, Zhang J, Mei ML, Li Q, Chu CH. The Antibacterial Mechanism of Silver Nanoparticles and Its Application in Dentistry. Int J Nanomed. 2020; 15:2555–2562. 15. Xu Y, Zheng B, He J, Cui Z, Liu Y. Silver nanoparticles promote osteogenic differentiation of human periodontal ligament fibroblasts by regulating the RhoA–TAZ axis. Cell Biol Int. 2019;43(8):910– 920. 16. Froelich A, Jakubowska E, Wojtyłko M, Jadach B, Gackowski M, Gadziński P, Napierała O, Ravliv Y, Osmałek T. Alginate-Based Materials Loaded with Nanoparticles in Wound Healing. Pharmaceutics. 2023 Apr 4;15(4):1142. 17. Kadkhodazadeh M, Baghani Z, Torshabi M, Basirat B. In Vitro Comparison of Biological Effects of CoePak and Reso-Pac Periodontal Dressings. J Oral Maxillofac Res. 2017 Mar 31;8(1):e3. 18. Singh M, Thakur V, Kumar V, Raj M, Gupta S, Devi N, Upadhyay SK, Macho M, Banerjee A, Ewe D, Saurav K. Silver nanoparticles and its mechanistic insight for chronic wound healing: review on recent progress. Molecules. 2022 Aug 30;27(17):5587. 19. Nasiri K, Masoumi SM, Amini S, Goudarzi M, Tafreshi SM, Bagheri A, Yasamineh S, Alwan M, Arellano MT, Gholizadeh O. Recent advances in metal nanoparticles to treat periodontitis. J. nanobiotech. 2023 Aug 21;21(1):283. 20. Moghareh AA, Yaghini J, Tavakoli M, AMJADI MR, Najafian E. Evaluation of the effect of postoperative packing of gingiva on clinical signs and symptoms: a pilot study.(2011) 705-711. 21. Jones TM, Cassingham RJ. Comparison of healing following periodontal surgery with and without dressings in humans. J Periodontol. 1979;50(8):387-93. 22. Liao J, Anchun M, Zhu Z, Quan Y. Antibacterial titanium plate deposited by silver nanoparticles exhibits cell compatibility. Int. j. Nanomed. 2010 May 13:337-342. 23. Reyes-Lopez SY. Bactericidal Activity of Silver Nanoparticles on Oral Biofilms Related to Patients with and without Periodontal Disease. Instituto de Ciencias Biomedicas. 2023 May 30.