Efficacy of 1% Metformin Gel in Patients With Moderate and Severe Chronic Periodontitis: A Randomized Controlled Clinical Trial.

BACKGROUND: The aim of this study is to investigate efficacy of metformin (MF) 1% gel as an adjunct to scaling and root planing (SRP) in the treatment of moderate and severe chronic periodontitis (CP). METHODS: Seventy patients were categorized into two treatment groups: 1) SRP plus 1% MF and 2) SRP plus placebo. Clinical parameters were recorded at baseline and 3, 6, and 9 months. They included plaque index (PI), modified sulcus bleeding index (mSBI), probing depth (PD), and clinical attachment level (CAL). Radiologic assessment of intrabony defects (IBDs) and percentage defect depth reduction (DDR%) was done at baseline and 6- and 9-month intervals using computer-aided software. PD, CAL, and DDR% were evaluated in two subgroups in both the placebo and MF group: 1) initial PD of 5 to 7 mm and 2) initial PD of >7 mm. RESULTS: Mean PD reduction and mean CAL gain was found to be greater in the MF group than the placebo group at all visits. Clinical parameters (PD, CAL) in both subgroups, with initial PDs of 5 to 7 and >7 mm, showed significant improvement in the 1% MF group compared with the placebo group. A significantly greater mean DDR% was found in the MF group than the placebo group at 6 and 9 months in both subgroups, 5 to 7 and >7 mm of initial PD. CONCLUSION: There was a greater decrease in PD and more CAL gain with significant IBD depth reduction at sites treated with SRP plus locally delivered MF in patients with CP in both initial PD = 5 to 7 and >7 mm subgroups compared with placebo.

Human chemerin correlation in gingival crevicular fluid and tear fluid as markers of inflammation in chronic periodontitis and type-2 diabetes mellitus.

AIM: The aim of the present study was to evaluate the levels and correlation of human chemerin in gingival crevicular fluid (GCF) and tear fluid in chronic periodontitis (CP) subjects with and without type-2 diabetes mellitus (DM). MATERIALS AND METHODS: A total of 40 subjects were divided into three groups: group 1 had 10 periodontally healthy subjects; group 2 consisted of 15 CP subjects and group 3 had 15 type-2 DM subjects with CP. The GCF and tear fluid levels of human chemerin were quantified using enzyme linked immunosorbent assay (ELISA). Systemic parameters such as body mass index, glycated hemoglobin levels and fasting plasma glucose levels were evaluated. The clinical outcomes evaluated were gingival index (GI), probing depth (PD), and clinical attachment level (CAL), and the correlations of the two inflammatory mediators with clinical parameters were evaluated. RESULTS: Human chemerin levels increased from group 1 to group 2 to group 3. The GCF and tear-fluid values of the inflammatory mediators correlated positively with each other and with the evaluated periodontal parameters (P < 0.05). CONCLUSION: Human chemerin can be considered as possible GCF and tear-fluid markers of inflammatory activity in CP and DM.

Efficacy of locally-delivered 1% metformin gel in the treatment of intrabony defects in patients with chronic periodontitis: a randomized, controlled clinical trial.

OBJECTIVE: Metformin (MF), used for the treatment of type 2 diabetes mellitus, has shown to possess properties favoring osteoblastic proliferation. The present study was designed to investigate the effectiveness of MF 1% gel as an adjunct to scaling and root planing in the treatment of intrabony defects in patients with chronic periodontitis. METHODS: The study comprised 65 individuals divided into two groups: 1% MF with SRP and placebo gel with SRP. Clinical parameters were evaluated at baseline, 3 months, and 6 months; they included plaque index, modified sulcus bleeding index, probing depth (PD), and clinical attachment level (CAL). Intrabony defect depth (IBD) was evaluated at the end of 6 months using computer-aided software. RESULTS: The mean PD reduction, CAL gain, and IBD depth reduction were found to be greater in the MF group than in the placebo group at all visits. The percentage of defect depth reduction was significantly greater in the MF group (26.8 ± 5.52%) than in the placebo sites (4.79 ± 2.30%, P < 0.001). CONCLUSION: One percent MF was found to significantly improve clinical and radiographic parameters in intrabony defects in patients with chronic periodontitis.

Levels of lipocalin-2 in crevicular fluid and tear fluid in chronic periodontitis and obesity subjects.

AIM: Lipocalin-2, a 25 kDa secretory glycoprotein, was first found in the neutrophilic granules of humans and in mouse kidney cells. It has been shown to have an important role in inflammation. The aim of this study was to determine the levels of lipocalin-2 in gingival crevicular fluid and tear fluid in patients with obesity and chronic periodontitis. METHODS: A total of 40 subjects in the age group 25-40 years were divided into four groups based on probing depth, gingival index, clinical attachment level, body mass index, and radiographic evidence of bone loss. The groups were: nonobese healthy group; obese healthy group; nonobese chronic periodontitis group; obese chronic periodontitis group Gingival crevicular fluid and tear fluid samples were collected on the subsequent day. RESULTS: There was an increase in lipocalin-2 levels from group 1 to group 4 (with the nonobese healthy group showing the least levels and obese chronic periodontitis group showing the highest levels) in both gingival crevicular fluid and tear fluid. CONCLUSION: Lipocalin-2 may be an important inflammatory marker that may help link obesity and chronic periodontitis.

Vaspin: a new adipokine correlating the levels of crevicular fluid and tear fluid in periodontitis and obesity.

AIM: In the present study, we investigated the levels of vaspin in gingival crevicular fluid (GCF) and tear fluid in obese patients with chronic periodontitis (CP), and sought to find an association, if any. METHODS: Forty patients (20 males and 20 females) with moderate-severe CP were selected based on their clinical parameters of gingival index, probing depth (PD), clinical attachment level (CAL), bleeding on probing, body mass index (BMI), and waist circumference, and divided into four groups (n = 10/group): group 1 (healthy non-obese), group 2 (healthy obese), group 3 (non-obese with CP), and group 4 (obese with CP). GCF and tear fluid vaspin levels were estimated by enzyme-linked immunosorbent assay. RESULTS: The mean vaspin concentration both in GCF and tear fluid was greater for group 4 (1.84 ± 0.03) and (1.98 ± 0.08), followed by groups 3 (1.35 ± 0.03 and 1.50 ± 0.06), 2 (0.95 ± 0.26 and 1.27 ± 0.51), and then 1 (0.65 ± 0.02 and 0.75 ± 0.02), respectively. Mean vaspin levels correlated with BMI, CAL, and PD. The association between GCF and tear fluid vaspin concentration was also statistically significant (P < 0.001). CONCLUSION: Vaspin can be a novel biomarker connecting inflammatory marker for the systemic inflammatory response in obesity and CP.

Rosuvastatin 1.2 mg In Situ Gel Combined With 1:1 Mixture of Autologous Platelet-Rich Fibrin and Porous Hydroxyapatite Bone Graft in Surgical Treatment of Mandibular Class II Furcation Defects: A Randomized Clinical Control Trial.

BACKGROUND: A wide range of regenerative materials have been tried and tested in the treatment of furcation defects. Rosuvastatin (RSV) is a new synthetic, second-generation, sulfur-containing, hydrophilic statin with potent anti-inflammatory and osseodifferentiation mechanisms of action. Platelet-rich fibrin (PRF) is a platelet concentrate having sustained release of various growth factors with regenerative potential to treat periodontal defects. Porous hydroxyapatite (HA) bone grafting material has a clinically satisfactory response when used to fill periodontal intrabony defects. This double-masked randomized study is designed to evaluate the potency of a combination of 1.2 mg RSV in situ gel with a 1:1 mixture of autologous PRF and HA bone graft in the surgical treatment of mandibular Class II furcation defects compared with autologous PRF and HA bone graft placed after open-flap debridement (OFD). METHODS: One hundred five mandibular furcation defects were treated with OFD + placebo gel (group 1), PRF + HA with OFD (group 2), or 1.2 mg RSV gel + PRF + HA with OFD (group 3). Clinical and radiologic parameters (i.e., probing depth [PD], relative vertical and relative horizontal clinical attachment level [rvCAL and rhCAL], intrabony defect depth, and percentage of defect fill) were recorded at baseline and 9 months postoperatively. RESULTS: Mean PD reduction was greater in group 2 (3.68 ± 1.07 mm) and group 3 (4.62 ± 1.03 mm) than group 1 (2.11 ± 1.25 mm), and mean rvCAL and rhCAL gain were greater in group 2 (3.31 ± 0.52 and 2.97 ± 0.56 mm, respectively) and group 3 (4.17 ± 0.70 and 4.05 ± 0.76 mm) compared with group 1 (1.82 ± 0.78 and 1.62 ± 0.64 mm). A significantly greater percentage of mean bone fill was found in group 2 (54.69% ± 1.93%) and group 3 (61.94% ± 3.54%) compared with group 1 (10.09% ± 4.28%). CONCLUSIONS: Treatment of furcation defects with 1.2 mg RSV in situ gel combined with autologous PRF and porous HA bone graft results in significant improvements of clinical and radiographic parameters compared with OFD alone. These results imply that the combination of RSV, PRF, and HA has synergistic effects, explaining their role as a regenerative material in the treatment of furcation defects.

Efficacy of locally delivered 1.2% rosuvastatin gel to non-surgical treatment of patients with chronic periodontitis: a randomized, placebo-controlled clinical trial.

BACKGROUND: Chronic periodontitis (CP) is an inflammatory condition affecting tooth-supporting tissues and alveolar bone that surround the tooth, leading to formation of a deepened gingival sulcus that is highly prone to pathologic changes and, ultimately, bone resorption and tooth loss. In the literature, several pharmacologic agents have been administered via local delivery routes directly into diseased sites, affirming improvement in periodontal status. Therefore, this study aims to determine the clinical effectiveness of subgingivally delivered 1.2% rosuvastatin (RSV) gel incorporated into a methylcellulose vehicle for its controlled release into intrabony defect (IBD) sites as an adjunct to scaling and root planing (SRP) for treatment of patients with CP. METHODS: Sixty-five patients were categorized into two treatment groups: group 1, SRP plus 1.2 mg RSV; group 2, SRP plus placebo. Clinical parameters, including modified sulcus bleeding index (mSBI), probing depth (PD), and clinical attachment level (CAL), were recorded at baseline (before SRP) and at 1, 3, 4, and 6 months. Radiologic assessment of IBD fill was analyzed at baseline and after 6 months using software. RESULTS: There was significant improvement in both study groups. At 6 months, there was a greater decrease in mSBI scores in group 1 (3.71 ± 0.24) compared to group 2 (1.48 ± 0.33). The mean decrease in PD from baseline to 6 months was 4.04 ± 0.34 and 1.31 ± 0.24 mm in groups 1 and 2, respectively. Mean CAL gain from baseline to 6 months was 4.2 ± 0.17 and 1.4 ± 0.15 mm in groups 1 and 2, respectively. In group 1, there was a greater decrease in mean IBD (2.23 ± 0.32 mm, 48.58%) compared to group 2 (0.46 ± 0.02 mm, 10.02%). All patients tolerated the drug without any adverse reaction. CONCLUSION: Rosuvastatin in situ gel (1.2%), when delivered locally into IBD/pocket sites, showed a greater reduction than placebo in PD and gingival index, along with increased gain in CAL.

Platelet-rich fibrin with 1% metformin for the treatment of intrabony defects in chronic periodontitis: a randomized controlled clinical trial.

BACKGROUND: Platelet-rich fibrin (PRF) is a second-generation platelet concentrate that releases various growth factors that promote tissue regeneration. Metformin (MF), a member of the biguanide group, has been shown to facilitate osteoblast differentiation and thus may exhibit a favorable effect on alveolar bone. The current study is designed to evaluate the efficacy of open-flap debridement (OFD) combined with PRF, 1% MF gel, and PRF + 1% MF gel in the treatment of intrabony defects (IBDs) in patients with chronic periodontitis (CP). METHODS: One hundred twenty patients with single defects were categorized into four treatment groups: OFD alone, OFD with PRF, OFD with 1% MF, and OFD with PRF plus 1% MF. Clinical parameters such as site-specific plaque index (PI), modified sulcus bleeding index (mSBI), probing depth (PD), relative attachment level (RAL), and gingival marginal level (GML) were recorded at baseline (before surgery) and 9 months postoperatively. Percentage radiographic IBD depth reduction was evaluated using computer-aided software at baseline and 9 months. RESULTS: PRF, 1% MF, and PRF + 1% MF groups showed significantly more PD reduction and RAL gain than the OFD-only group. Mean PD reduction and mean RAL gain were found to be greater in the PRF + 1% MF group compared to just PRF or MF at 9 months. Furthermore, PRF + 1% MF group sites showed a significantly greater percentage of radiographic defect depth reduction (52.65% ± 0.031%) compared to MF (48.69% ± 0.026%), PRF (48% ± 0.029%), and OFD alone (9.14% ± 0.04%) at 9 months. CONCLUSION: The PRF + 1% MF group showed greater improvements in clinical parameters, with greater percentage radiographic defect depth reduction compared to MF, PRF, or OFD alone in treatment of IBDs in patients with CP.