Nanotheranostics in Periodontitis: Bridging Diagnosis and Therapy Through Smart Integrated Nanosystems

Periodontitis is a chronic, multifactorial inflammatory disease characterized by the progressive destruction of the tooth-supporting structures. Conventional therapeutic approaches, including mechanical debridement and systemic antibiotics, often fall short in achieving complete bacterial eradication or tissue regeneration, particularly in deep periodontal pockets. Nanotheranostics—an integrated platform combining diagnostics and therapeutics within a single nanosystem—holds promise in advancing periodontal care through targeted delivery, real-time disease monitoring, and site-specific therapy. This narrative review examines the potential of various nanomaterials for building nanotheranostic systems to overcome current clinical limitations, including non-specific drug delivery, insufficient treatment monitoring, and delayed intervention, and their functionalization and responsiveness to the periodontal microenvironment are discussed. Their application in targeted antimicrobial, anti-inflammatory, and regenerative therapy is discussed in terms of real-time monitoring of disease biomarkers and pathogenic organisms. Although nanoparticle-based therapeutics have been extensively studied in periodontitis, the integration of diagnostic elements remains underdeveloped. This review identifies key translational gaps, evaluates emerging dual-function platforms, and discusses challenges related to biocompatibility, scalability, and regulatory approval. In particular, inorganic nanomaterials exhibit potential for theranostic functions such as antimicrobial activity, biofilm disruption, immunomodulation, tissue regeneration, and biosensing of microbial and inflammatory biomarkers. Finally, we propose future directions to advance nanotheranostic research toward clinical translation. By consolidating the current evidence base, this review advocates for the development of smart, responsive nanotheranostic platforms as a foundation for personalized, minimally invasive, and precision-guided periodontal care.