Bio-nano architectures as therapeutic platforms: mechanism-driven precision anti-infective therapy for periodontal regeneration

Periodontitis affects nearly 50% of the global population. The main challenges are three major bottlenecks faced by traditional mechanical debridement and antibiotics: drug resistance, difficulty controlling deep infections, and imbalance in the immune-osteogenic microenvironment. This article systematically reviews how the latest 'bio-nanostructures' achieve mechanism-driven precision anti-infection and periodontal regeneration. First, it outlines the three major pathological networks, immunometabolism, autophagy, and gene-non-coding RNA, to identify key nodes in plaque evasion and bone homeostasis disruption. Next, it categorizes targeted drug delivery and multi-factor co-delivery strategies based on inorganic, organic, and composite platforms that respond to ROS, pH, and enzymes. The article emphasizes five synergistic mechanisms including chemodynamic therapy, gaseous, sonodynamic, photothermal, and piezoelectric/pH responsiveness clarifying how the spatiotemporal cascade of antibacterial-anti-inflammatory-immune regulation-osteogenesis achieves closed-loop therapy. Finally, it proposes multi-omics guidance, personalized module design, and clinical translation pathways, providing a replicable engineering blueprint for next-generation periodontal nanotherapies.