Current clinical management of periodontitis, a chronic inflammatory disease driven by dysbiotic biofilms, faces a persistent challenge: biofilm-associated infections remain difficult to eradicate owing to the resilient energy metabolism and high virulence of key pathogens such as Porphyromonas gingivalis. To address this challenge, we developed ultrasmall AHMP-stabilized gold nanoclusters (AHMP@AuNCs) based on a bioenergetics-centered "Metabolic Trap" paradigm. Their sub-2-nm architecture supports bacterial-interior access, while preferential bacterial accumulation may be facilitated by the pyrimidine-mimetic ligand environment, potentially through pyrimidine-associated recognition or uptake processes. A proton-responsive Au-ligand interface undergoes reversible electronic-state modulation, with near-neutral to weakly alkaline intracellular conditions favoring a charge-transfer-associated state. Following bacterial accumulation, AHMP@AuNCs disrupt proton homeostasis and energetic coupling, leading to ATP and NAD depletion, nucleotide metabolic imbalance, secondary oxidative stress, and suppression of T9SS-dependent virulence. Integrated metabolomic and transcriptomic analyses reveal coordinated rewiring of energy, nucleotide, and virulence networks, supporting the "Metabolic Trap" concept. Across oral biofilm models, AHMP@AuNCs inhibit biofilm formation and access internal regions of mature biofilms, disrupting established architecture while showing limited cytotoxicity in the evaluated host-cell models. In experimental periodontitis, local administration preserved epithelial barrier integrity, attenuated inflammation, reduced the P. gingivalis-associated burden, and limited periodontal tissue destruction, with favorable short-term tolerability. This strategy demonstrates that targeting intracellular energy vulnerabilities can achieve antibacterial, antibiofilm, and antivirulence effects against persistent infections.
Implant-associated infections (IAIs) persist as a critical complication in biomaterial transplantation, driven by rapid microbial colonization, biofilm encapsulation, and escalating antibiotic resistance. Conventional antibiotic-based treatments and passive antimicrobial coatings often fail to achieve long-term infection control due to limited biofilm penetration, localized cytotoxicity, and active agent depletion. To overcome these limitations, piezoelectric nanocomposite coatings utilize a dynamic, stimulus-responsive framework that converts physiological mechanical forces or external ultrasound into localized electrical signals. These surface-bound electric fields systematically mitigate bacterial adhesion, eradicate mature biofilms via targeted reactive oxygen species (ROS) generation, disrupt microbial metabolic pathways, and favorably modulate the peri-implant immune microenvironment while supporting host tissue repair. This review evaluates the material design principles and classifications of inorganic, organic, and hybrid piezoelectric nanocoatings. We detail their multifaceted antibacterial mechanisms and trace their therapeutic potential in orthopedic and dental implants, as well as wound management. Lastly, we analyze current engineering bottlenecks to chart a clear trajectory for their clinical translation.