Periodontal Treatment for Chronic Periodontitis With Rheumatoid Arthritis

BackgroundHistory of rheumatoid arthritis (RA) increases risk of periodontal diseases. A pro-inflammatory condition noted in periodontitis is considered a trigger for RA. Thus, periodontal treatment aimed at attenuating the pro-inflammatory state could aid in potentially reducing the risk of RA.AimsThe objective of this research was to assess the effect of periodontal therapy on rheumatoid factor, Disease Activity Score-28, anti-citrullinated protein antibody, and C-reactive protein levels in patients with chronic periodontitis (CP) and RA.Materials and methodsThe sample consisted of 28 patients with CP and RA. The study was designed to be a double-blind, randomised controlled clinical study. The samples were randomly categorised to either the treatment group (n = 13) or the control group (n = 15). CP status (plaque index, bleeding on probing, probing pocket depth, clinical attachment loss), clinical rheumatologic status (Disease Activity Score), and biochemical status (C-reactive protein, anti-citrullinated protein antibody, and rheumatoid factor) were assessed at baseline and at follow-up at 8 to 12 weeks.ResultsThe treatment group showed a highly statistically significant reduction in bleeding on probing (P < .005), probing pocket depth (P < .001), plaque index (P < .001), and C-reactive protein (P < .001); a gain in the clinical attachment loss (P < .001) and an improvement in Disease Activity Score-28 (P = .001) were observed at reassessment following nonsurgical periodontal treatment as compared to the control group. However, blood serum anti-citrullinated protein antibody (P = .002) and rheumatoid factor levels (P = .351) were found to increase from baseline to 8 to 12 weeks following subgingival scaling and root planing.ConclusionsReduction of inflammation in the periodontium by nonsurgical periodontal therapy did not reduce anti-citrullinated protein antibody and rheumatoid factor levels. However, it has shown improvement in periodontal conditions, and remarkable changes were observed in the clinical Disease Activity Score and C-reactive protein levels of individuals with RA.     

Association Among Oral Health Parameters,Periodontitis, and Its Treatment and Mortality in Patients Undergoing Hemodialysis

Background: Chronic periodontitis (CP) is a continuous, reversible source of inflammation with a potential impact on mortality in patients undergoing hemodialysis (HD). This study investigates the impact of oral health indicators, CP, and its treatment on survival rates in a group of patients undergoing HD. Methods: Clinically stable patients undergoing HD were referred for a dental examination. All patients were prospectively followed in the dialysis clinic, and all‐cause mortality was recorded. Three groups of patients were analyzed: those who received CP treatment, those who did not, and patients without CP as a control group. Results: A total of 122 patients (79 males and 43 females, aged 23 to 77 years; mean age: 50 years; range: 23 to 77 years) were enrolled. Forty percent reported having rarely been evaluated by a dentist, and 59% had CP. There were 34 fatal events during a mean follow‐up time of 64.1 ± 11.2 months. Oral factors associated with death in the univariate analysis were decreased frequency of dental visits; non‐use of dental floss; increased decayed, missing, and filled teeth index; presence of CP; and absence of CP treatment. Patients with CP had a higher risk of death from all causes compared with patients without CP in the univariate analysis for untreated patients (hazard ratio 2.65 [95% confidence interval 1.06 to 6.59]; P = 0.036) and to a lesser extent for treated patients (2.36 [1.01 to 5.59]; P = 0.047). These significant differences were not maintained after adjustments for confounders in the multivariate model. Conclusions: These results suggest that poor oral health, including CP, is a common finding in patients undergoing HD. The results of this study call for intervention trials to test the hypothesis that treatment of CP improves survival in maintenance of patients undergoing HD.     

Periodontal Treatment Decreases Levels of Antibodies to Porphyromonas gingivalis and Citrulline in Patients With Rheumatoid Arthritis and Periodontitis

Background: Porphyromonas gingivalis has been implicated as an etiologic agent of rheumatoid arthritis (RA) because of the expression of peptidylarginine deiminase. The present study evaluates whether periodontal treatment may affect serum antibodies to P. gingivalis and citrulline levels in relation to disease activity of RA. Methods: Fifty‐five patients with RA were randomly assigned to receive oral hygiene instruction and supragingival scaling (treatment group, n = 26) or no periodontal treatment (control group, n = 29). Periodontal and rheumatologic parameters and serum levels of cytokine and inflammatory markers citrulline and immunoglobulin (Ig)G to P. gingivalis were examined at baseline and 8 weeks later. Results: Both groups did not differ statistically in any parameters except percentage of sites with probing depth and clinical attachment level ≥4 mm at baseline. The treatment group exhibited a significantly greater decrease in disease activity score including 28 joints using C‐reactive protein (DAS28‐CRP) (P = 0.02), serum levels of IgG to P. gingivalis hemin binding protein (HBP)35 (P = 0.04), and citrulline (P = 0.02) than the control group. Serum levels of IgG to P. gingivalis HBP35 were significantly correlated positively with those of anti‐cyclic citrullinated peptide antibodies (P = 0.0002). The same correlation was obtained between serum levels of IgG to P. gingivalis–sonicated extracts and those of rheumatoid factor (P = 0.02). Conclusions: These results suggest that supragingival scaling decreases DAS28‐CRP and serum levels of IgG to P. gingivalis HBP35 and citrulline in patients with RA. These observations may reflect a role of P. gingivalis in the protein citrullination, which is related to the pathogenesis of RA.     

Effect of Glycemic Control on Self‐Perceived Oral Health,Periodontal Parameters,and Alveolar Bone Loss Among Patients With Prediabetes

Background: The effect of glycemic control on severity of periodontal inflammatory parameters in patients with prediabetes is unknown. The aim of the present study is to assess the effects of glycemic control on self‐perceived oral health, periodontal parameters, and marginal bone loss (MBL) in patients with prediabetes. Methods: A total of 303 individuals were included. Hemoglobin A1c (HbA1c) and fasting blood glucose levels (FBGLs) were recorded. Participants were divided into three groups: 1) group A: 75 patients with prediabetes (FBGLs = 100 to 125 mg/dL [HbA1c ≥5%]); 2) group B: 78 individuals previously considered prediabetic but having FBGLs <100 mg/dL (HbA1c <5%) resulting from dietary control; and 3) control group: 150 medically healthy individuals. Self‐perceived oral health, socioeconomic status, and education status were determined using a questionnaire. Plaque index (PI), bleeding on probing (BOP), probing depth (PD), and clinical attachment loss (AL) were recorded. Premolar and molar MBLs were measured on panoramic radiographs. Results: Periodontal parameters (PI, BOP, PD, and AL) (P <0.01) and MBL (P <0.01) were worse among individuals in group A than those in group B. Self‐perceived gingival bleeding (P <0.001), pain on chewing (P <0.001), dry mouth (P <0.001), and oral burning sensations (P <0.05) were worse among patients in group A than those in group B. There was no difference in periodontal parameters, MBL, and self‐perceived oral symptoms among patients with prediabetes in group B and healthy controls. Conclusions: Self‐perceived oral health, severity of periodontal parameters, and MBL are worse in patients with prediabetes than controls. Glycemic control significantly reduces the severity of these parameters as well as the state of prediabetes in affected individuals.     

Microbiologic Observations After Four Treatment Strategies Among Patients With Periodontitis Maintaining a High Standard of Oral Hygiene: Secondary Analysis of a Randomized Controlled Clinical Trial

Background: The benefit of full‐mouth disinfection (FDIS) over traditional scaling and root planing (SRP), with or without adjunctive metronidazole, when treating chronic destructive periodontitis remains equivocal, as does the long‐term association between clinical and microbiologic outcomes after such strategies. The aim of this study is to examine the relationship between clinical and microbiologic outcomes of four different treatment strategies for chronic destructive periodontitis among patients who maintain excellent oral hygiene and low gingival bleeding scores. Methods: One hundred eighty‐four patients with periodontitis and capable of maintaining a high standard of oral hygiene were randomly allocated to one of four treatment groups: 1) FDIS + metronidazole; 2) FDIS + placebo; 3) SRP + metronidazole; and 4) SRP + placebo. Recordings of plaque, bleeding on probing, probing depth (PD), and clinical attachment level were carried out in four sites per tooth at baseline, 3 and 12 months after treatment. Before treatment, pooled subgingival samples were obtained from the five deepest pockets, which were sampled again 3 and 12 months after treatment. Microbiologic assessments of eight putative periodontal pathogens were performed using the checkerboard DNA‐DNA hybridization method. Results: Levels of bacterial species were already relatively low at baseline. The only microbial factor statistically significantly associated with the clinical outcomes of treatment after 12 months was the association between reductions of Tannerella forsythia and being free from PD ≥5 mm. Conclusion: In this clinical trial, the only microbial factor associated with the clinical outcomes after 12 months was a statistically significant association between the reductions of T. forsythia and being free from PD ≥5 mm.     

Duraphat对慢性牙周炎患者基础治疗疗效观察和疼痛感受评价

目的:观察Duraphat对慢性牙周炎患者基础治疗疗效观察和疼痛感受评价。方法:选择80例慢性牙周炎维护期的患者,其全口4个象限每个象限至少各有2颗牙齿, 其邻面至少有1位点探诊深度>4 mm,有探诊出血, 根据随机表将4个象限随机分常规牙周基础治疗A组和基础治疗结合DuraphatB组两组。根据牙周探诊深度分为PD≥4 mm和PD>6 mm。常规牙周基础治疗组42例, 基础治疗结合Duraphat组38例。记录基线和治疗后1个月和3个月时,入选位点的牙周探诊深度、临床附着丧失、出血指数及刮治当时的疼痛程度VAS值。比较治疗后与治疗前的差值。结果:牙周探诊深度、临床附着丧失和出血指数在治疗后各组都有明显改善,同时患者在治疗中的疼痛程度涂布Duraphat组较常规组VAS值明显降低。结论:Duraphat可以对不同程度的慢性牙周炎患者基础治疗辅助使用,并可以明显降低病人的疼痛感受。     

8‐Hydroxy‐Deoxyguanosine Levels in Gingival Crevicular Fluid and Saliva in Patients With Chronic Periodontitis After Initial Periodontal Treatment

Background: This study evaluates the effects of initial periodontal treatment on the gingival crevicular fluid (GCF) and salivary levels of 8‐hydroxy‐deoxyguanosine (8‐OHdG) as a marker of oxidative deoxyribonucleic acid (DNA) damage in patients with chronic periodontitis (CP). Methods: At baseline, clinical parameters were determined and GCF and saliva samples were obtained from 24 patients with CP and 24 individuals with clinically healthy periodontium. GCF, saliva samples, and clinical periodontal measurements were repeated at day 10, 1 month, and 3 months following initial periodontal therapy in patients with CP. 8‐OHdG levels of GCF and saliva samples were investigated by using an enzyme‐linked immunosorbent assay. Results: Statistically significant higher 8‐OHdG levels of GCF and a significant decrease after initial periodontal therapy were determined in the CP group (P <0.001). A significant positive correlation was found between 8‐OHdG levels of GCF and clinical periodontal measurements (P <0.001). However, salivary levels of 8‐OHdG did not differ between groups or during initial periodontal therapy (P >0.05). Conclusions: This study reveals that DNA injury and oxidative stress increase in tissue cells and especially in periodontal pockets in patients with CP, and the periodontal treatment results in a significant decrease of 8‐OHdG levels in the GCF samples. To the best of our knowledge, this study evaluates for the first time, 8‐OHdG levels in GCF, which is shown to be more useful as a biomarker than saliva. 8‐OHdG was found to be important and may reveal the severity of periodontal disease and the effect of periodontal therapy.     

Surgical Treatment for Patients With Periodontal Disease Reduces Risk of End‐Stage Renal Disease: A Nationwide Population‐Based Retrospective Cohort Study

Background: The association between periodontal disease treatment and end‐stage renal disease (ESRD) remains unclear. This study aims to determine whether surgical periodontal treatment reduces ESRD risk. Methods: From the insurance claims data of patients with periodontal disease who were free of ESRD from 1997 to 2009, 35,496 patients were identified who underwent surgery for subgingival curettage and/or periodontal flap and are considered the treatment cohort. For comparison, 141,824 patients who did not undergo these treatments were considered the no‐treatment cohort. Follow‐ups were performed until the end of 2009 to estimate the incidence and risk of ESRD in these two cohorts. Cox proportional hazard regression was used to estimate the related hazard ratio (HR) and 95% confidence interval (CI) of ESRD. Results: The incidence of ESRD was lower in the treatment cohort than in the no‐treatment cohort (4.66 versus 7.38 per 10,000 person‐years), with an adjusted HR of 0.59 (95% CI = 0.46 to 0.75). Sex‐ and age‐specific analysis showed that the incidence rate ratio of the treatment cohort to the no‐treatment cohort was higher for women than for men and declined with age. The risks of ESRD were consistently lower in the treatment cohort even when compared by comorbidity. Conclusions: Patients with periodontal disease who undergo procedures for subgingival curettage and/or periodontal flap have a remarkably decreased risk of ESRD.     

Effect of Chronic Periodontitis on Serum and Gingival Crevicular Fluid Oxidant and Antioxidant Status in Patients With Familial Mediterranean Fever Before and After Periodontal Treatment

Background: The aim of this study is to investigate the impact of periodontal status on oxidant/antioxidant status in patients with chronic periodontitis (CP) who experienced familial Mediterranean fever (FMF) and their response to non‐surgical periodontal therapy. Methods: Data were obtained from 13 patients with FMF with generalized CP (FMF‐CP), 15 systemically healthy patients with generalized CP, 15 systemically and periodontal healthy controls (HCs), and 14 periodontally healthy patients with FMF (FMF‐HC). Each participant's total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) in their gingival crevicular fluid (GCF) and serum were recorded. Probing depth, clinical attachment level, and gingival and plaque indices in each participant were also measured. The GCF and clinical parameters at baseline and 6 weeks after periodontal treatment were recorded. Results: The study showed statistically significant improvement of clinical parameters in both FMF‐CP and CP groups after periodontal treatment. The baseline GCF‐TOS and OSI levels were significantly higher in the CP group compared with the FMF‐CP group (P <0.05). After periodontal treatment, the GCF‐TOS levels were significantly reduced in members of the FMF‐CP group (P <0.05). The GCF‐TAS levels in members of the FMF‐CP group were significantly higher than those of members of the HC group at baseline (P <0.05). Serum‐TAS levels in the FMF‐CP group were significantly higher than those in the CP and HC groups at baseline (P <0.05). The GCF‐TOS level in the FMF‐CP group was significantly higher than that in the FMF‐HC group at baseline and 6 weeks. However, there were no significant differences in the serum‐TOS and serum‐OSI levels of those in the FMF‐CP and CP groups at baseline and 6 weeks (P >0.05). Conclusion: The results of the present study show that patients with FMF‐CP displayed reduced oxidative stress and increased antioxidant status compared with those in the CP and HC groups.     

Clinical,Microbial, and Immune Responses Observed in Patients With Diabetes After Treatment for Gingivitis: A Three‐Month Randomized Clinical Trial

Background: Although patients with diabetes are frequently affected by periodontitis, only a few investigations have focused on gingivitis in this at‐risk population. This randomized placebo‐controlled clinical trial compared the response to a gingivitis treatment protocol that combined mechanical procedures and daily use of an essential oil (EO) mouthrinse between patients with and without diabetes. Methods: The whole‐mouth periodontal probing depth (PD), gingival index (GI), and plaque index (PI) were monitored in gingivitis cases among systemically healthy patients (n = 60) or those with diabetes (n = 60) at baseline and 3 months after treatment. Levels of Porphyromonas gingivalis, Tannerella forsythia, Aggregatibacter actinomycetemcomitans, and total bacterial load were determined by a real‐time polymerase chain reaction in intrasulci plaque samples. The volume of gingival crevicular fluid (GCF) was quantified, and interleukin‐1β (IL‐1β) levels were determined in GCF samples. After a full‐mouth ultrasonic debridement, patients were randomly assigned to an EO or a placebo rinse for 90 days (40 mL/day). The data were analyzed through repeated‐measures analysis of variance and multiple comparisons Tukey tests (P <0.05). Results: GI was more severe in the diabetes group. Diabetes impaired GI and reduced GCF volume. PD, bacterial levels, and IL‐1β improved similarly in both systemic conditions. The adjunctive use of EO provided greater reductions of PI, GI, total bacterial load, T. forsythia, A. actinomycetemcomitans, and GCF volume. Conclusions: Response to gingivitis treatment in patients with diabetes can slightly differ from that in patients without diabetes. Daily use of an EO mouthrinse after ultrasonic debridement benefited patients with and without diabetes.     

Effect of Non‐Surgical Periodontal Treatment on Visfatin Concentrations in Serum and Gingival Crevicular Fluid of Patients With Chronic Periodontitis and Type 2 Diabetes Mellitus

Background : This study aims to assess visfatin concentrations in serum and gingival crevicular fluid (GCF) and investigate this relationship in patients with type 2 diabetes mellitus (T2DM) and chronic periodontitis (CP) before and after non‐surgical periodontal treatment. Methods: Fifty‐four patients with T2DM and CP were recruited. The patients were randomly divided into two groups: treatment and control. Serum and GCF visfatin concentrations and glycated hemoglobin (HbA1c) levels were measured by enzyme‐linked immunosorbent assay at different time points (at baseline and 3 and 6 months after non‐surgical periodontal treatment). Results: Serum and GCF visfatin concentrations showed no significant differences between the groups at baseline (t test, P >0.05). A significant decline of visfatin in the treatment group was found in serum and GCF 3 months after non‐surgical periodontal treatment (t test, P <0.01). Baseline and 3‐month HbA1c levels were not significantly different, but at 6 months, a statistically significant difference was detected (t test, P >0.05). Conclusions: The data suggest that non‐surgical periodontal treatment is helpful for glucose control, an effect that may be associated with reduced visfatin in patients with T2DM and periodontitis. Furthermore, the data suggest that visfatin may be considered an inflammatory marker for periodontal diseases.     

Effectiveness of Periodontal Treatment to Improve Metabolic Control in Patients With Chronic Periodontitis and Type 2 Diabetes: A Meta‐Analysis of Randomized Clinical Trials

Background: It was recently suggested that scaling and root planing (SRP) may help to improve glycemic and metabolic control in patients with chronic periodontitis (CP) and type 2 diabetes mellitus (DM2); however, the effectiveness of SRP in this role remains unclear. This meta‐analysis assesses the effectiveness of SRP in improving glycemic and metabolic control in patients with CP and DM2. Methods: A literature search of electronic databases was performed for articles published through May 16, 2012, followed by a manual search of several dental journals. A meta‐analysis was conducted according to the recommendations of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). Weighted mean differences (MDs) and 95% confidence intervals (CIs) were calculated for glycated hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), and high‐ and low‐density lipoprotein cholesterol (HDL and LDL, respectively). All outcomes were evaluated as changes from baseline to the end of follow‐up. Heterogeneity was assessed with the χ²‐based Cochran Q test and I² statistic. The level of significance was set at P < 0.05. Results: After the study selection process, five randomized clinical trials were included. Results of the meta‐analysis indicated that SRP was effective in the reduction of HbA1c (MD = 0.65; 95% CI 0.43 to 0.88; P <0.05) and FPG (MD = 9.04; 95% CI 2.17 to 15.9; P <0.05), but no significant differences were found in the reduction of TC, TG, HDL, or LDL. No evidence of heterogeneity was detected. Conclusion: The meta‐analysis results seem to support the effectiveness of SRP in the improvement of glycemic control in patients with CP and DM2; however, future studies are needed to confirm these results.     

Enamel Matrix Derivative,Alone or Associated With a Synthetic Bone Substitute,in the Treatment of 1‐ to 2‐Wall Periodontal Defects

Background: In this study, we compare the effects of enamel matrix derivative (EMD) associated with a hydroxyapatite and β‐tricalcium phosphate (HA/β‐TCP) implant to EMD alone and to open‐flap debridement (OFD) when surgically treating 1‐ to 2‐wall intrabony defects. Methods: Thirty‐four patients, exhibiting ≥3 intraosseous defects in different quadrants, were each treated by OFD, EMD, or EMD + HA/β‐TCP in each defect. At baseline and 12 and 24 months, a complete clinical and radiographic examination was done. Pre‐therapy and post‐therapy clinical (probing depth [PD], clinical attachment level [CAL], and gingival recession [GR]) and radiographic (defect bone level [DBL] and radiographic bone gain [RBG]) parameters for the different treatments were compared. Results: After 12 and 24 months, almost all the clinical and radiographic parameters showed significant changes from baseline within each group (P <0.001). Differences in PD, CAL, and DBL scores were also seen among the three groups at the 12‐ and 24‐month visits (P <0.001). At 12 and 24 months after treatment, the EMD + HA/β‐TCP group showed significantly greater PD reduction (4.00 ± 0.42 mm; 4.25 ± 0.63 mm), CAL gain (3.47 ± 0.65 mm; 3.63 ± 0.91 mm), and RBG (3.17 ± 0.69 mm; 3.35 ± 0.80 mm) and less GR increase (0.56 ± 0.37 mm; 0.63 ± 0.42 mm) compared with the OFD and EMD groups (P <0.05). Conclusion: Our data support the hypothesis that the adjunct of an HA/β‐TCP composite implant with EMD may improve the clinical and radiographic outcomes of the surgical treatment of unfavorable intrabony defects.     

The Sociodemographic Characteristics,Periodontal Health Status,and Subgingival Microbiota of Patients With Chronic Periodontitis and Type 2 Diabetes Mellitus: A Case‐Control Study in a Chinese Population

Background: In China, chronic periodontitis (CP) is common in patients with type 2 diabetes mellitus (T2DM). The purpose of this study is to identify the sociodemographic characteristics associated with such patients and to assess the periodontal health status and subgingival microbiota of patients with CP and T2DM (T2DMCP) in the Chinese population. Methods: A total of 150 patients with T2DMCP and 306 patients with CP without any systemic disease completed questionnaires, underwent clinical periodontal examinations and participated in diabetes‐related parameter examinations. Subgingival plaques were obtained to determine the prevalence and amounts of selected oral bacterial species using polymerase chain reaction (PCR) and real‐time PCR, respectively. Results: The income level and mean body mass index (BMI) of the patients with T2DMCP were significantly higher than those of the patients with CP. Additionally, the patients with T2DMCP were more likely to be urban residents, and they had significantly more severe periodontitis than did the patients with CP. In the patients with T2DMCP, the prevalence and amounts of Treponema denticola and Tannerella forsythia were significantly higher than those in the patients with CP. Finally, compared with the patients with CP, the patients with T2DMCP had a significantly lower prevalence and amount of Prevotella intermedia. Conclusions: Compared with the patients with CP, the patients with T2DMCP were more likely to be urban residents and generally had higher incomes, higher mean BMI, and poorer periodontal health status. Higher levels of T. denticola and T. forsythia and lower levels of P. intermedia were identified in the subgingival plaque of the patients with T2DMCP.     

Platelet‐Rich Fibrin Combined With 1.2% Atorvastatin for Treatment of Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial

Background: Platelet‐rich fibrin (PRF), a second‐generation platelet concentrate, and atorvastatin (ATV), a potent member of the statin group, are known to promote tissue regeneration. The current study is designed to evaluate combined efficacy of PRF and 1.2% ATV gel with open flap debridement (OFD) in treatment of intrabony defects (IBDs) in individuals with chronic periodontitis (CP). Methods: Ninety‐six individuals with single defects were categorized into three groups: 1) OFD with PRF; 2) OFD with PRF + 1.2% ATV; and 3) OFD alone. Clinical parameters: 1) site‐specific plaque index; 2) modified sulcus bleeding index; 3) probing depth (PD); 4) relative clinical attachment level (rCAL); and 5) gingival marginal level were recorded at baseline before surgery and 9 months postoperatively. Percentage radiographic IBD depth reduction was evaluated at baseline and 9 months. Results: PRF + 1.2% ATV and PRF alone showed significantly greater PD reduction and rCAL gain compared with OFD alone at 9 months. Furthermore, PRF + 1.2% ATV showed a similar percentage radiographic defect depth reduction (50.96% ± 4.88%) compared with PRF alone (47.91% ± 4.79%), and a greater reduction compared with OFD alone (5.54% ± 1.71%) at 9 months. Conclusions: PRF + 1.2% ATV showed similar improvements in clinical parameters with a greater percentage radiographic defect depth reduction compared with PRF alone in treatment of IBDs in individuals with CP. Thus, 1.2% ATV failed to augment the regenerative potential of PRF alone in periodontal IBDs.     

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.