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Lin SY, Sun JS, Lin IP, Hung MC, Chang JZC. Efficacy of adjunctive local periodontal treatment for type 2 diabetes mellitus patients with periodontitis: A systematic review and network meta-analysis. J Dent 2024; 148:105212. [PMID: 38936456 DOI: 10.1016/j.jdent.2024.105212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVES To investigate the effectiveness of different adjunctive local treatments combined with non-surgical periodontal therapy (NSPT) to reduce pocket depth (PD), gain clinical attachment level (CAL), and/or reduce glycated hemoglobin (HbA1c) in individuals with both type 2 diabetes mellitus (T2DM) and periodontitis in a systematic review and network meta-analysis. DATA SOURCES Publications were searched in Cochrane databases, EMBASE, Google Scholar, MEDLINE, PubMed, opengrey.eu, and www. CLINICALTRIALS gov up to May 29, 2024 with no language restriction. STUDY SELECTION Only randomized controlled trials (RCTs) were included. Network meta-analysis utilized frequentist models. DATA The network meta-analysis of 30 RCTs involving 1224 patients revealed that, in short-term (2-3 months) and medium-term (4-6 months), adjunctive local treatment involving statins or metformin significantly outperformed scaling and root planning (SRP) with/without additional interventions such as photodynamic and laser therapies (PDT/LT), phytotherapy, doxycycline, bisphosphonates, antibiotics, antiseptics, or placebo for reducing PD and/or gaining CAL. In the long-term (>6 months), statins yielded the most significant additional PD reduction and CAL gain, followed by antibiotics, compared to SRP with antiseptics or placebo. Only PDT/LT demonstrated significantly greater HbA1c reduction in the short term compared to SRP with/without statins, antiseptics, or placebo. CONCLUSION This study moderately supports that adding metformin or statins locally to NSPT may enhance PD reduction and CAL gain compared to SRP with/without placebo. CLINICAL SIGNIFICANCE Clinicians are guided to optimize adjunctive therapies, enhancing the health of patients with type 2 diabetes and periodontitis. A strategic approach is proposed to tackle systemic and oral health challenges simultaneously.
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Affiliation(s)
- Shih-Ying Lin
- Department of Dentistry, MacKay Memorial Hospital, Taipei, Taiwan
| | - Jui-Sheng Sun
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan; Department of Orthopedic Surgery, En Chu Kong Hospital, Taipei, Taiwan
| | - I-Ping Lin
- Department of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Min-Chih Hung
- Department of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jenny Zwei-Chieng Chang
- Department of Dentistry, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan; School of Dentistry, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Montalbán-Vadillo O, Pérez-Pevida E, Viteri-Agustín I, Chávarri-Prado D, Estrada-Martínez A, Diéguez-Pereira M, Sánchez-Lasheras F, Brizuela-Velasco A. Effect of Applying 1% Metformin on Guided Bone Regeneration Processes with Bovine-Derived Xenografts. J Clin Med 2024; 13:2973. [PMID: 38792514 PMCID: PMC11122524 DOI: 10.3390/jcm13102973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Although xenografts have shown successful results in GBR procedures due to their osteoconductive properties, many authors have opted to add co-adjuvant drugs to favor osteogenesis and differentiate cells into an osteoblastic lineage. Metformin has been shown to have bone-protective properties, regulating osteoclast differentiation, as well as the ability to promote osteoblast mineralization and differentiation. The present study aimed to evaluate the effect of the local application of a 1% metformin solution on bone neoformation in the treatment of an experimental bone defect in a guided bone regeneration animal model with a particulated bovine hydroxyapatite xenograft with hyaluronate. Methods: With this purpose in mind, two critical defects with 8 mm diameter and 0.5 mm depth were created in eight male New Zealand rabbit calvarias. Titanium cylinders were fixed in each defect and filled with particulate hydroxyapatite of bovine origin and sodium hyaluronate, with sterile injectable saline added to the control group and sterile 1% metformin solution added to the test group. At 6 weeks, the animals were euthanized, and samples were obtained and prepared for histomorphometric analysis. Results: A higher percentage of new bone formation was observed in the metformin samples than in the control samples, both in the region closest to the animal's calvaria and in the most distal region analyzed. A higher average bone-biomaterial contact percentage was observed in the samples, with metformin in both the proximal and distal regions. There was no statistically significant difference in the mean value in either region in both parameters. Conclusion: The local application of a 1% metformin solution in an animal model of guided bone regeneration with particulate bovine hydroxyapatite and hyaluronate resulted in greater bone neoformation and xenograft osseointegration than in the control group.
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Affiliation(s)
- Oier Montalbán-Vadillo
- Department of Surgery, Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain
| | - Esteban Pérez-Pevida
- Department of Surgery, Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain
- Faculty of Health Sciences, Miguel de Cervantes European University, 47012 Valladolid, Spain
- EDE-SRGROUP, La Salle Higher Center for University Studies, 28023 Madrid, Spain
| | - Iratxe Viteri-Agustín
- Faculty of Health Sciences, Miguel de Cervantes European University, 47012 Valladolid, Spain
| | - David Chávarri-Prado
- Faculty of Health Sciences, Miguel de Cervantes European University, 47012 Valladolid, Spain
| | | | - Markel Diéguez-Pereira
- Faculty of Health Sciences, Miguel de Cervantes European University, 47012 Valladolid, Spain
| | - Fernando Sánchez-Lasheras
- University Institute of Space Sciences and Technologies of Asturias (ICTEA), University of Oviedo, 33004 Oviedo, Spain
- Department of Mathematics, Faculty of Sciences, University of Oviedo, 33007 Oviedo, Spain
| | - Aritza Brizuela-Velasco
- Faculty of Health Sciences, Miguel de Cervantes European University, 47012 Valladolid, Spain
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Hammad Uddin MK, Khan Sadiq MS, Ahmed A, Khan M, Maniar T, Mateen SM, Saba B, Kashif SM, Usman S, Najeeb S, Khurshid Z, Zafar MS. Applications of Metformin in Dentistry-A review. J Taibah Univ Med Sci 2023; 18:1299-1310. [PMID: 37275952 PMCID: PMC10239065 DOI: 10.1016/j.jtumed.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/10/2023] [Accepted: 03/30/2023] [Indexed: 06/07/2023] Open
Abstract
Metformin is a versatile drug with numerous medical uses. It is known primarily as an anti-hyperglycemic drug that has become the main oral blood-glucose-lowering medication for managing type 2 diabetes mellitus globally. Its use has been reported in a variety of oral conditions and dentistry in general. Recent clinical trials have indicated the effectiveness of adjunct topical application of metformin in improving the periodontal parameters of patients with diabetes and periodontitis. Additionally, studies have suggested that metformin stimulates odontogenic differentiation and mineral synthesis of stem cells in the tooth pulp. Metformin also stimulates osteoblast proliferation, decreases osteoclast activity and exerts regenerative effects on periodontal bone, thus making it a viable candidate for periodontal regeneration. Metformin monotherapy significantly enhances osseointegration of endosseous implants and has been reported to have anti-cancer effects on oral squamous cell carcinoma by impeding tumor progression. Animal studies have indicated that metformin improves orthodontic tooth movement and resists orthodontic appliance corrosion. This narrative review aims to provide a current summary of research highlighting the prospective uses of metformin in dentistry.
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Affiliation(s)
- Muhammad Khawaja Hammad Uddin
- Department of Science of Dental Materials, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Sindh, Pakistan
- School of Dental Care Professionals (SDCP), Dow University of Health Sciences Karachi, Sindh, Pakistan
| | - Muhammad Shahrukh Khan Sadiq
- Department of Oral Pathology, Bahria University Dental College, Bahria University Health Sciences Campus (Karachi) Karachi, Sindh, Pakistan
| | - Ashfaq Ahmed
- Department of Science of Dental Materials, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Sindh, Pakistan
- Department of Oral Pathology, Bahria University Dental College, Bahria University Health Sciences Campus (Karachi) Karachi, Sindh, Pakistan
| | - Mariam Khan
- Department of Science of Dental Materials, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Sindh, Pakistan
- Department of Oral Pathology, Bahria University Dental College, Bahria University Health Sciences Campus (Karachi) Karachi, Sindh, Pakistan
| | - Tooba Maniar
- Department of Science of Dental Materials, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, Sindh, Pakistan
- Department of Oral Pathology, Bahria University Dental College, Bahria University Health Sciences Campus (Karachi) Karachi, Sindh, Pakistan
| | - Syeda Mamoona Mateen
- Dr Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Sindh, Pakistan
| | - Bilquees Saba
- Dr Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Sindh, Pakistan
- Department of Medicine, Ziauddin Medical College, Ziauddin University, Karachi, Sindh, Pakistan
| | - Syed Muhammad Kashif
- Dr Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Sindh, Pakistan
- Department of General Medicine, Civil Hospital, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Shumaila Usman
- Dr Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Sindh, Pakistan
- Department of Molecular Medicine, Ziauddin Medical College, Ziauddin University, Karachi, Sindh, Pakistan
| | - Shariq Najeeb
- Evidentia Dental Outcomes Research, Calgary, Alberta, Canada
- Schulich Dentistry, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C, Canada
| | - Zohaib Khurshid
- Department of Prosthodontics and Dental Implantology, King Faisal University, Hofuf, Al-Ahsa, Saudi Arabia
- Center of Excellence for Regenerative Dentistry, Department of Anatomy, Faculty of Dentistry, Chulalongkorn University, Bangkok 10330, Thailand
| | - Muhammad Sohail Zafar
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Al Madina Al Munawara, 41311, Saudi Arabia
- Department of Dental Materials, Islamic International Dental College, Riphah International University, Islamabad 44000, Pakistan
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Sobhnamayan F, Sahebi S, Moazami F, Malekzadeh P, Hasani S. Combination of metformin and double antibiotic paste for the regeneration of non-vital immature teeth: a preliminary randomized clinical study. BMC Oral Health 2023; 23:847. [PMID: 37951861 PMCID: PMC10638745 DOI: 10.1186/s12903-023-03591-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 10/28/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND The present study aimed to investigate whether incorporating metformin in double antibiotic paste (DAP) can promote the regeneration process of non-vital immature teeth. METHODS Out of 32 pediatric patients undergoing regenerative endodontic procedures (REPs), 6 cases with a follow-up period of less than 12 months or lack of documentation were excluded then the remaining 26 were analyzed. 15 cases received DAP, and 11 cases received a DAP + metformin as the intra-canal medicament, kept for an average of 23 days. During 18 months of follow-up, clinical and radiographic examinations were performed to evaluate the treatment outcomes based on the resolution of apical periodontitis, root development, and the occurrence of intracanal calcification. The chi-square test was used for the statistical analysis (P < 0.05). RESULTS All patients demonstrated resolution of apical periodontitis; however, complete apical closure was only seen in 50% of the patients. The rate of apical closure and root length was significantly higher in the DAP + metformin group (P = 0.047), although the two groups were not significantly different in terms of root width (P = 0.184). Canal obliteration was seen in 15% of cases, all of which were in the DAP group. CONCLUSIONS According to the present findings, metformin could promote root development in the regeneration process when incorporated in DAP. TRIAL REGISTRATION This clinical trial was registered on the Iranian Registry of Clinical Trials (IRCT20200120046197N1) on 26.2.2021.
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Affiliation(s)
- Fereshte Sobhnamayan
- Department of Endodontics, Faculty of Dentistry, Shiraz University of Medical Sciences, Qasrdasht St., Shiraz, 71956-15878, Iran
| | - Safoora Sahebi
- Department of Endodontics, Faculty of Dentistry, Shiraz University of Medical Sciences, Qasrdasht St., Shiraz, 71956-15878, Iran.
| | - Fariborz Moazami
- Department of Endodontics, Faculty of Dentistry, Shiraz University of Medical Sciences, Qasrdasht St., Shiraz, 71956-15878, Iran
| | - Parastoo Malekzadeh
- Department of Endodontics, Faculty of Dentistry, Lorestan University of Medical Sciences, Lorestan, Iran
| | - Soheila Hasani
- Department of Endodontics, Faculty of Dentistry, Yasuj University of Medical Sciences, Yasuj, Iran
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Krishnakumar G, Koppu S, Dev JN, Songa VM, Buggapati L, Mandrachalam R. Clinical efficacy of 1% metformin gel around conventionally placed dental implants: A 9-month follow-up study. J Indian Soc Periodontol 2023; 27:626-635. [PMID: 38434514 PMCID: PMC10906785 DOI: 10.4103/jisp.jisp_534_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 05/28/2023] [Accepted: 11/08/2023] [Indexed: 03/05/2024] Open
Abstract
Aim The study aimed to compare the clinical and radiographic outcomes of bone volume, density, and crestal bone levels in conventionally placed dental implants with and without local application of 1% metformin (MF) gel using cone-beam computed tomography (CBCT) at 9 months. Materials and Methods Twenty implants were placed in 18 individuals, randomly divided into 2 groups where Group A received a local application of 1% MF gel along with implant placement. In contrast, Group B received implant placement alone. After thorough clinical examination and preoperative CBCTs, implants were placed under aseptic conditions. Patients were recalled at 3 and 9 months after surgery. Implants were functionally loaded by the end of 3rd month. Soft-tissue parameters such as modified plaque index and modified sulcular bleeding index were recorded along with CBCT evaluation to assess the crestal bone loss, bone density measurement, and bone volume, postoperatively. Fisher's extract test, independent and paired t-test, and Bonferroni analysis were used to determine statistical significance with P ≤ 0.05. Results There was no discernible difference between the groups regarding soft-tissue parameters, bone density, and crestal bone levels. However, comparing bone volume between the test and control groups at 9 months was statistically significant. The test group with 1% MF gel showed increased bone volume around the implant. Conclusion The data obtained were strong enough to suggest that 1% MF gel administered locally can increase peri-implant bone volume, possibly due to its additional property favoring osteoblastic stimulation and proliferation.
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Affiliation(s)
- Govardhani Krishnakumar
- Department of Periodontology, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India
| | - Sitamahalakshmi Koppu
- Department of Periodontology, Kamineni Institute of Dental Science and Research, Nalgonda, Telangana, India
| | - Jampani Narendra Dev
- Department of Periodontology, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India
| | - Vajra Madhuri Songa
- Department of Periodontology, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India
| | - Lahari Buggapati
- Department of Periodontology, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India
| | - Radhika Mandrachalam
- Department of Periodontology, JKKN Dental College and Hospital, Erode, Tamil Nadu, India
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Gegout PY, Stutz C, Huck O. Gels as adjuvant to non-surgical periodontal therapy: A systematic review and meta-analysis. Heliyon 2023; 9:e17789. [PMID: 37455970 PMCID: PMC10345361 DOI: 10.1016/j.heliyon.2023.e17789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/14/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
Objective This systematic review and meta-analysis evaluated the effect of the use of available drugs loaded gels used as adjunct to non-surgical periodontal therapy. Methods Systematic research on PubMed/MEDLINE, Cochrane Central register of Controlled Trials, and Embase databases up to December 2021 was performed. Randomized clinical trials (RCT) which compared the outcomes of scaling and root planing (SRP) + local adjuvant administration (gel) versus SRP + placebo or SRP alone in Humans were included. The primary outcome measures were PPD and CAL changes at 3 months. Results After articles screening, 77 articles were included and assessed for quality. Then, a meta-analysis was conducted in studies with at least 3 months of follow-up. Clinical improvements were found to be significant for tetracyclines (-0.51 [-0.71;-0.31] p < 0.001), macrolides (-0.71 [-1.04;-0.38] p < 0.001), statins (-0.84 [-0.98;-0.70] p < 0.001), metformin (-1.47 [-1.66;-1.29] p < 0.001) and hyaluronan (-1.61 [-2.28;-0.94] p < 0.001) loaded gels, but non-significant for chlorhexidine (-0.48 [-1.10; 0.14] p = 0.13), metronidazole (-0.50 [-1.20; 0.20] p = 0.16) and bisphosphonates (-0.42 [-1.39; 0.54] p = 0.539) gels. Conclusion Adjunctive use of drugs loaded gels to non-surgical periodondal treatment could improve PPD reduction at 3 months. However, huge disparities remain when comparing the outcomes of the differents drugs used. Future comparative studies should be considered to determine precisely short and long term benefits of such treatments.
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Affiliation(s)
- Pierre-Yves Gegout
- Université de Strasbourg, Faculté de Chirurgie Dentaire, Periodontology, Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Pôle de Médecine et Chirurgie Bucco-dentaires, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Céline Stutz
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Olivier Huck
- Université de Strasbourg, Faculté de Chirurgie Dentaire, Periodontology, Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Pôle de Médecine et Chirurgie Bucco-dentaires, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
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Arena C, Mariani P, Russo D, Zhurakivska K, Laino L. Adjunctive use of locally delivered host-modulators in intra-bony defects as part of step 2 periodontal therapy: systematic review, meta-analysis and trial sequential analysis. Evid Based Dent 2023; 24:91-92. [PMID: 37165061 DOI: 10.1038/s41432-023-00877-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/22/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND This systematic review and meta-analysis aimed at investigate the role of locally delivered host-modulators in combination with step 2 of periodontal therapy in reducing probing pocket depth, improving clinical attachment level and reducing bone defect depth in intra-bony defects. HIGHLIGHT RCT with at least 6 months follow-up were included in this study. Risk of bias assessment was performed with Cochrane collaboration tool and Grade GRADEpro. In addition, meta-analysis and trial sequential analysis were used to aggregate the available evidence. 22 studies met the inclusion criteria and were included in this systematic review. At 6 months locally delivered host-modulators significantly improved PD and CAL and bone defect depth. CONCLUSION Considering the emerging role of host-inflammatory response in the treatment of periodontitis, several studies are exploring the role of locally delivered host modulators as an adjunct to step 2 of periodontal therapy.
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Affiliation(s)
- Claudia Arena
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80121, Naples, Italy.
| | - Pierluigi Mariani
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", 80121, Naples, Italy
| | - Diana Russo
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", 80121, Naples, Italy
| | - Khrystyna Zhurakivska
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122, Foggia, Italy
| | - Luigi Laino
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", 80121, Naples, Italy
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Ikhar AS, Kolte RA, Kolte AP, Purohit AR, Dahake RN. Efficacy of platelet rich fibrin with and without metformin in the treatment of periodontal osseous defects: a systematic review and meta-analysis. Acta Odontol Scand 2023; 81:186-195. [PMID: 35786379 DOI: 10.1080/00016357.2022.2095024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The systematic review and meta-analysis aimed to evaluate the efficacy of Metformin (MF) with Platelet Rich Fibrin (PRF) over PRF alone in the treatment of periodontal osseous defects. MATERIALS AND METHODS An extensive electronic search for articles published up to September 2021 was conducted on 'Embase', 'PubMed' and other library databases accompanied with manual searching. Randomized controlled trials (RCTs), comparing MF plus PRF Vs PRF alone in periodontal osseous defects were identified in which periodontal pocket depth (PPD), Clinical attachment level (CAL) and Intrabony defect depth (IBD Depth) were the outcome measures. RESULTS Four studies compared MF plus PRF vs .PRF alone in periodontal osseous defects. Meta-analysis was carried out for PPD reduction, CAL gain and IBD Depth changes. A standardized mean difference (SMD) of 1.86 for PPD reduction, 1.95 for CAL gain and 1.31 for IBD Depth reduction in all the studies was observed and the findings were statistically significant favouring test group. CONCLUSION The systematic review indicates supplemental benefits of combination therapy of MF + PRF over monotherapy in resolving periodontal osseous defects. In our quest to achieve maximum regeneration in periodontal osseous defects, combination therapies such as MF + PRF have reported to be better treatment choices over other modalities.
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Affiliation(s)
- Aishwarya S Ikhar
- Department of Periodontology and Implant Dentistry, VSPM Dental College and Research Centre, Nagpur, India
| | - Rajashri A Kolte
- Department of Periodontology and Implant Dentistry, VSPM Dental College and Research Centre, Nagpur, India
| | - Abhay P Kolte
- Department of Periodontology and Implant Dentistry, VSPM Dental College and Research Centre, Nagpur, India
| | - Aishwarya R Purohit
- Department of Periodontology and Implant Dentistry, VSPM Dental College and Research Centre, Nagpur, India
| | - Rahul N Dahake
- Department of Oral and Maxillofacial Surgery, VSPM Dental College and Research Centre, Nagpur, India
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Aljofi FE, Alesawy A, Alzaben B, Alshaikh M, Alotaibi N, Aldulaijan HA, Alshehri S, Aljoghaiman E, Al-Dulaijan YA, AlSharief M. Impact of Metformin on Periodontal and Peri-Implant Soft and Hard Tissue. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1095. [PMID: 36673851 PMCID: PMC9859401 DOI: 10.3390/ijerph20021095] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
Periodontal and peri-implant soft and hard tissue in diabetic patients have always been a topic of interest for researchers and clinicians alike. Among which, a subtopic that has attracted more attention is the beneficial effect of metformin (MF) on periodontal and peri-implant soft and hard tissue. This review aimed to assess the impact of MF on the periodontal and peri-implant soft- and hard-tissue healing among diabetic patients. Research was conducted using the keywords 'metformin', 'diabetes', 'periodontitis', 'implant', and 'peri-implantitis' via the Medline (PubMed) and Google Scholar databases. Selected articles were reviewed. A total of 21 articles, discussing the impact on periodontal health (six animal studies, seven clinical studies, and three systematic reviews) and five studies on peri-implant health (four animal studies and one clinical study) were included. All have reported a positive impact of MF on decreasing the inflammatory response, oxidative stress, and ultimate bone loss. Similarly, human studies reported a positive effect of MF on clinical and radiographic parameters compared with controls. Despite systematic reviews reporting heterogeneity among the included studies, MF has shown a positive impact on periodontal health. In animal, clinical studies, and systematic reviews, MF showed a protective impact on periodontal and peri-implant health.
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Affiliation(s)
- Faisal E. Aljofi
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Aminah Alesawy
- Fellowship in Periodontics Program, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Bader Alzaben
- Fellowship in Periodontics Program, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Marwa Alshaikh
- Fellowship in Periodontics Program, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Norah Alotaibi
- Fellowship in Periodontics Program, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Hajer A. Aldulaijan
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh P.O. Box 60169, Saudi Arabia
| | - Sami Alshehri
- Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Eman Aljoghaiman
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Yousif A. Al-Dulaijan
- Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
| | - Mishali AlSharief
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia
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Tao LY, Łagosz-Ćwik KB, Hogervorst JMA, Schoenmaker T, Grabiec AM, Forouzanfar T, van der Weijden FA, de Vries TJ. Diabetes Medication Metformin Inhibits Osteoclast Formation and Activity in In Vitro Models for Periodontitis. Front Cell Dev Biol 2022; 9:777450. [PMID: 35096812 PMCID: PMC8793072 DOI: 10.3389/fcell.2021.777450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Diabetes and periodontitis are comorbidities and may share common pathways. Several reports indicate that diabetes medication metformin may be beneficial for the periodontal status of periodontitis patients. Further research using appropriate cell systems of the periodontium, the tissue that surrounds teeth may reveal the possible mechanism. Periodontal ligament fibroblasts anchor teeth in bone and play a role in the onset of both alveolar bone formation and degradation, the latter by inducing osteoclast formation from adherent precursor cells. Therefore, a cell model including this type of cells is ideal to study the influence of metformin on both processes. We hypothesize that metformin will enhance bone formation, as described for osteoblasts, whereas the effects of metformin on osteoclast formation is yet undetermined. Periodontal ligament fibroblasts were cultured in the presence of osteogenic medium and 0.2 or 1 mM metformin. The influence of metformin on osteoclast formation was first studied in PDLF cultures supplemented with peripheral blood leukocytes, containing osteoclast precursors. Finally, the effect of metformin on osteoclast precursors was studied in cultures of CD14+ monocytes that were stimulated with M-CSF and receptor activator of Nf-κB ligand (RANKL). No effects of metformin were observed on osteogenesis: not on alkaline phosphatase activity, Alizarin red deposition, nor on the expression of osteogenic markers RUNX-2, Collagen I and Osteonectin. Metformin inhibited osteoclast formation and accordingly downregulated the genes involved in osteoclastogenesis: RANKL, macrophage colony stimulating factor (M-CSF) and osteoclast fusion gene DC-STAMP. Osteoclast formation on both plastic and bone as well as bone resorption was inhibited by metformin in M-CSF and RANKL stimulated monocyte cultures, probably by reduction of RANK expression. The present study unraveling the positive effect of metformin in periodontitis patients at the cellular level, indicates that metformin inhibits osteoclast formation and activity, both when orchestrated by periodontal ligament fibroblasts and in cytokine driven osteoclast formation assays. The results indicate that metformin could have a systemic beneficiary effect on bone by inhibiting osteoclast formation and activity.
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Affiliation(s)
- Lucy Y Tao
- Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije University Amsterdam, Amsterdam, Netherlands.,Amsterdam University College, University of Amsterdam and Vrije University Amsterdam, Amsterdam, Netherlands
| | - Katarzyna B Łagosz-Ćwik
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland
| | - Jolanda M A Hogervorst
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije University Amsterdam, Amsterdam, Netherlands
| | - Ton Schoenmaker
- Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije University Amsterdam, Amsterdam, Netherlands
| | - Aleksander M Grabiec
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Kraków, Poland
| | - Tim Forouzanfar
- Department of Oral and Maxillofacial Surgery and Oral Pathology, Amsterdam UMC, Amsterdam, Netherlands
| | - Fridus A van der Weijden
- Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije University Amsterdam, Amsterdam, Netherlands
| | - Teun J de Vries
- Department of Periodontology, Academic Centre for Dentistry Amsterdam, University of Amsterdam and Vrije University Amsterdam, Amsterdam, Netherlands
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11
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Effects of type 2 diabetes and metformin on salivary microbiota in patients with chronic periodontitis. Microb Pathog 2021; 161:105277. [PMID: 34740808 DOI: 10.1016/j.micpath.2021.105277] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/11/2021] [Accepted: 11/01/2021] [Indexed: 12/28/2022]
Abstract
Diabetes is closely associated with periodontitis, however, the effects of type 2 diabetes and metformin treatment on the salivary microbiota in chronic periodontitis patients are still insufficiently studied. Saliva was collected from ten patients with moderate to severe chronic periodontitis (CP group) and 20 patients with type 2 diabetes mellitus (T2DM) and moderate to severe chronic periodontitis (ten patients were newly diagnosed with diabetes without drug treatment (DM group), and ten patients were treated with metformin (CP-DM-MET group)). Total DNA was extracted. DNA amplicons of the V3-V4 hypervariable regions of the 16S rRNA gene were generated and subjected to high-throughput sequencing. There was no significant difference in the alpha diversity of the salivary microbiota (Observed_Species, Shannon, Simpson, ACE, Chao1 index) among the three groups. The dominant phyla with relative abundances greater than 1% were Firmicutes, Proteobacteria, Bacteroidota, Actinobacteriota, Fusobacteriota, and Spirochaetota, and no significant difference was found among the three groups. Compared with the CP group, the relative abundance of twelve genera was found changed in CP-DM group, for example, Aggregatibacter, Unclassified_f_Neisseriaceae, Parvimonas, Erysipelotrichace_UCG-006, Atopobium, and Endomicrobium et al. Metformin treatment could partly restore the abundance of several genera in CP-DM, such as Acholeplasma and Comamonas. Compared with the CP group, genus Lactobacillus, Parvimonas, Norank_f_norank_o_Absconditabacteriales_SR1, and Acholeplasma changed significantly in CP-DM-MET group. Plaque index (PLI) was positively correlated with Prevotella and Lactobacillus but negatively correlated with Haemophilus, Lautropia, Unclassified_f_Pasteurellaceae, and TM7x. In conclusion, there was a significant difference in the salivary microbiota of patients with chronic periodontitis complicated by T2DM. Treatment with metformin partially alleviated the alteration in salivary microbiota caused by T2DM.
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12
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Gunsolley JC, Al-Abedalla K, Shaqman M, Ioannidou E. Unusual Findings in Trials Evaluating Adjuncts to Scaling and Root Planing: Meta-analysis (Part 1). JDR Clin Trans Res 2021; 7:234-241. [PMID: 34609240 DOI: 10.1177/23800844211039722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A number of studies in patients with periodontitis have compared scaling and root planning (SRP) combined with an adjunctive treatment to SRP alone. Within that literature, an array of studies with overlapping investigators has consistently yielded substantially greater effects of adjunctive treatments than had been previously noted. This report investigates discrepancies between that cluster of research and the most recent American Dental Association (ADA) systematic review. METHODS This review was preregistered at https://osf.io/4meyd/. A search using the Scopus platform identified 32 articles published from 2010 to 2017 by investigators affiliated with the Government Dental College and Research Institute (GDCRI) in Bangalore, India. The primary outcome used in this meta-analysis was the change in clinical attachment level (CAL) after 6 mo. Effect sizes were estimated using Comprehensive Meta-Analysis software after categorizing agents into groups based on pharmacologic similarity. RESULTS The search identified 32 studies encompassing 5 sets of adjunctive agents. Across the GDCRI studies, the CAL averaged 1.67 mm (95% confidence interval [CI]: 1.43-1.91 mm), substantially exceeding values reported in the ADA review (mean: 0.39 mm, 95% CI: 0.27-0.51 mm). For categories of studies in which comparable subgroup estimates were available, the evaluations yielded overlapping estimates of SRP alone, but CAL estimates were discrepant for both locally delivered antimicrobials (GDCRI studies: mean: 1.45 mm, 95% CI: 0.63-2.27 mm; ADA review: mean: 0.38 mm, 95% CI: 0.16 -0.60 mm) and systemic antibiotics (GDCRI studies: mean: 1.35 mm, 95% CI: 0.97-1.73 mm; ADA review: mean: 0.39 mm, 95% CI: 0.21-0.57 mm). CONCLUSION In the literature on adjunctive agents supplementing SRP, findings from investigators linked to GDCRI stand out as having significantly more favorable estimated effects. Meanwhile, some agents studied by GDCRI-linked investigators have not been investigated by other researchers. In the absence of a clear explanation for discrepant results, it is recommended that unusually favorable reported effects of adjunctive agents be viewed with caution. KNOWLEDGE TRANSFER STATEMENT The present meta-analysis observed an unusually large effect size of adjunctive agents to scaling and root planning in studies conducted by the same research group. These results were not consistent with trials on adjunctive agents and previous reports. As this research group has exclusively tested most of the agents, their results must be viewed with caution until other independent groups replicate the studies and reproduce the effect size.
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Affiliation(s)
- J C Gunsolley
- Department of Periodontics, Virginia Commonwealth University School of Dentistry, Richmond, VA, USA
| | - K Al-Abedalla
- Division of Periodontology, School of Dental Medicine, UCONN Health, Farmington, CT, USA
| | - M Shaqman
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, School of Dentistry, The University of Jordan, Amman, Jordan
| | - E Ioannidou
- Division of Periodontology, School of Dental Medicine, UCONN Health, Farmington, CT, USA
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13
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Swami RK, Kolte AP, Kolte RA. Clinico-radiographic comparative evaluation of 1% metformin gel plus platelet-rich fibrin over platelet-rich fibrin alone in treatment of Grade II furcation defects: A randomized controlled double-blind clinical trial. J Periodontol 2021; 93:644-655. [PMID: 34533832 DOI: 10.1002/jper.21-0233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND The present study was aimed to evaluate and compare the effects of 1% MF plus PRF over PRF alone in treatment of Grade II furcation defects, clinically and radiographically by using cone-beam computed tomography. METHODS This split-mouth clinical trial randomly allotted 21 patients with 42 bilateral Grade II furcation defects into two groups. Group I was treated with PRF alone while Group II with 1% MF gel and PRF. The primary outcome parameters were clinical attachment level (CAL) and horizontal probing depth (HPD) while the secondary outcome parameters were probing depth (PD) and defect volume (DV). The clinical parameters were evaluated at 3, 6, and 12 months and the radiographic parameters at 12 months. RESULTS Both the study groups yielded improvements in assessed parameters; however, significantly greater mean reduction of PD, HPD, and CAL gain was observed in Group II (3.90 ± 0.78 mm, 2.94 ± 0.80 mm, and 3.42 ± 0.93 mm) in comparison with Group I (3.23 ± 0.90 mm, 1.96 ± 0.80 mm, and 2.67 ± 0.88 mm) at 12 months, respectively. A significant reduction of DV was exhibited radiographically in Group II (12.61 ± 4.01 mm3 ) as compared with Group I (9.14 ± 4.31 mm3 ) at the end of 12 months. CONCLUSIONS Better clinical and radiographic findings in terms of reduction in PD, HPD, CAL gain, and significant reduction in DV in Group II patients indicated that the combination therapy of 1% MF + PRF promotes regenerative ability within the periodontal tissues in Grade II furcation defects to a greater extent.
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Affiliation(s)
- Renuka K Swami
- Department of Periodontics & Implantology, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Abhay P Kolte
- Department of Periodontics & Implantology, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
| | - Rajashri A Kolte
- Department of Periodontics & Implantology, VSPM Dental College and Research Centre, Nagpur, Maharashtra, India
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14
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Donos N, Calciolari E, Brusselaers N, Goldoni M, Bostanci N, Belibasakis GN. The adjunctive use of host modulators in non-surgical periodontal therapy. A systematic review of randomized, placebo-controlled clinical studies. J Clin Periodontol 2021; 47 Suppl 22:199-238. [PMID: 31834951 DOI: 10.1111/jcpe.13232] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/10/2019] [Accepted: 12/01/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Considering the role of the inflammatory host response in the pathogenesis of periodontitis, different host modulators have been proposed to enhance the outcomes of non-surgical periodontal therapy (NSPT), but their efficacy has not been fully clarified. OBJECTIVES This systematic review investigated the efficacy of host modulators combined with NSPT in reducing probing pocket depth (PPD) in periodontitis patients. MATERIALS AND METHODS Placebo-controlled RCTs with ≥6 months follow-up were searched. Meta-analysis was conducted when ≥5 studies using the same host modulator were identified. RESULTS Fifty eight studies met the inclusion criteria. After 6 months, local administration of 1.2% statin gels as adjuncts to NSPT significantly improved PPD reduction (1.83 mm) in infrabony defects and systemic administration of sub-antimicrobial dose doxycycline (SDD) in addition to NSPT improved PPD reduction of deep pockets. Administration of probiotics conferred limited clinical benefits. Local bisphosphonate and metformin gels showed potential for clinical use in infrabony defects, which needs to be confirmed. CONCLUSIONS Local delivery of statins in infrabony defects and systemic SDD for deep pockets may confer additional clinical benefits to NSPT. Their long-term effectiveness and safety need to be confirmed in independent multi-centred studies. Further studies are needed to confirm the benefit of other host modulators.
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Affiliation(s)
- Nikolaos Donos
- Centre for Oral Immunobiology & Regenerative Medicine & Centre for Oral Clinical Research, Barts and The London School of Medicine & Dentistry, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - Elena Calciolari
- Centre for Oral Immunobiology & Regenerative Medicine & Centre for Oral Clinical Research, Barts and The London School of Medicine & Dentistry, Institute of Dentistry, Queen Mary University of London (QMUL), London, UK
| | - Nele Brusselaers
- Centre of Translational Microbiome Research, Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Stockholm, Sweden
| | - Matteo Goldoni
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Nagihan Bostanci
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Georgios N Belibasakis
- Division of Oral Diseases, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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15
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Fakhri E, Eslami H, Maroufi P, Pakdel F, Taghizadeh S, Ganbarov K, Yousefi M, Tanomand A, Yousefi B, Mahmoudi S, Kafil HS. Chitosan biomaterials application in dentistry. Int J Biol Macromol 2020; 162:956-974. [DOI: 10.1016/j.ijbiomac.2020.06.211] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 12/23/2022]
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16
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Petit C, Batool F, Stutz C, Anton N, Klymchenko A, Vandamme T, Benkirane-Jessel N, Huck O. Development of a thermosensitive statin loaded chitosan-based hydrogel promoting bone healing. Int J Pharm 2020; 586:119534. [PMID: 32531451 DOI: 10.1016/j.ijpharm.2020.119534] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 01/04/2023]
Abstract
Statins have been proposed as potential adjuvant to periodontal treatment due to their pleiotropic properties. A new thermosensitive chitosan hydrogel loaded with statins (atorvastatin and lovastatin) nanoemulsions was synthesized to allow a spatially controlled local administration of active compounds at lesion site. Spontaneous nano-emulsification method was used to synthesize statins loaded nanoemulsions. In vitro, atorvastatin and lovastatin loaded nanoemulsions were cytocompatible and were able to be uptake by oral epithelial cells. Treatment of Porphyromonas gingivalis infected oral epithelial cells and gingival fibroblasts with atorvastatin and lovastatin loaded nanoemulsions decreased significantly pro-inflammatory markers expression (TNF-α and IL-1β) and pro-osteoclastic RANKL. Nevertheless, such treatment induced the expression of Bone sialoprotein 2 (BSP2) in osteoblast emphasizing the pro-healing properties of atorvastatin and lovastatin nanoemulsions. In vivo, in a calvarial bone defect model (2 mm), treatment with the hydrogel loaded with atorvastatin and lovastatin nanoemulsions induced a significant increase of the neobone formation in comparison with systemic administration of statins. This study demonstrates the potential of this statins loaded hydrogel to improve bone regeneration and to decrease soft tissue inflammation. Its use in the specific context of periodontitis management could be considered in the future with a reduced risk of side effects.
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Affiliation(s)
- Catherine Petit
- INSERM, UMR 1260 'Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France; Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France; Pôle de Médecine et de Chirurgie Bucco-Dentaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Fareeha Batool
- INSERM, UMR 1260 'Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France; Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France
| | - Céline Stutz
- INSERM, UMR 1260 'Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Nicolas Anton
- Université de Strasbourg, CNRS, CAMB UMR 7199, Strasbourg, France
| | - Andrey Klymchenko
- Université de Strasbourg, CNRS, LBP UMR 7021, F-67000 Strasbourg, France
| | - Thierry Vandamme
- Université de Strasbourg, CNRS, CAMB UMR 7199, Strasbourg, France
| | - Nadia Benkirane-Jessel
- INSERM, UMR 1260 'Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Olivier Huck
- INSERM, UMR 1260 'Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France; Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France; Pôle de Médecine et de Chirurgie Bucco-Dentaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
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17
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Zhang R, Liang Q, Kang W, Ge S. Metformin facilitates the proliferation, migration, and osteogenic differentiation of periodontal ligament stem cells in vitro. Cell Biol Int 2020; 44:70-79. [PMID: 31293042 DOI: 10.1002/cbin.11202] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/07/2019] [Indexed: 01/24/2023]
Abstract
Periodontitis is one of the main causes of tooth loss and has been confirmed as the sixth complication of diabetes. Metformin promotes the osteogenic differentiation of stem cells. Periodontal ligament stem cells (PDLSCs) are the best candidate stem cells for periodontal tissue regeneration. Herein, we aimed to identify the effects of metformin on the proliferation, migration, and osteogenic differentiation of PDLSCs in vitro. PDLSCs were isolated by limiting dilution, and their characteristics were assessed by colony formation assay and flow cytometry. Cell counting and migration assays were used to investigate the effects of metformin on proliferation and migration. The osteogenic differentiation ability of PDLSCs was detected by alkaline phosphatase (ALP) activity and Alizarin Red S staining. Gene and protein levels of osteogenesis-related markers were determined by quantitative real-time polymerase chain reaction (qRT-PCR) and western blot analysis, respectively. Metformin treatment at 10 μM did not affect PDLSC proliferation, while at 50 and 100 μM, metformin time-dependently enhanced PDLSC proliferation and significantly increased cell numbers after 5 and 7 days of stimulation (P < 0.05). In addition, 50 μM metformin exhibited a maximal effect on migration, ALP activity, and mineral deposition (P < 0.05). Furthermore, 50 μM metformin significantly upregulated the gene expression levels of ALP, BSP, OPN, OCN, and Runx2 and the protein expression of ALP and Runx2 (P < 0.05). In summary, our study confirms that metformin facilitates the proliferation, migration, and osteogenic differentiation of PDLSCs in vitro and could be used as a new strategy for periodontal tissue regeneration.
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Affiliation(s)
- Rui Zhang
- Department of Periodontology, School and Hospital of Stomatology, Shandong University & Shandong Provincial Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, No. 44-1 Wenhua Road West, Jinan, 250012, China
- Department of Endodontics, Hospital of stomatology, Zunyi medical University, No. 149 Dalian Road, Zunyi, 563000, China
| | - Qianyu Liang
- Department of Periodontology, School and Hospital of Stomatology, Shandong University & Shandong Provincial Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, No. 44-1 Wenhua Road West, Jinan, 250012, China
| | - Wenyan Kang
- Department of Periodontology, School and Hospital of Stomatology, Shandong University & Shandong Provincial Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, No. 44-1 Wenhua Road West, Jinan, 250012, China
| | - Shaohua Ge
- Department of Periodontology, School and Hospital of Stomatology, Shandong University & Shandong Provincial Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, No. 44-1 Wenhua Road West, Jinan, 250012, China
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18
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Khalifehzadeh S, Haghanifar S, Jenabian N, Kazemi S, Hajiahmadi M. Clinical and radiographic evaluation of applying 1% metformin biofilm with plasma rich in growth factor (PRGF) for treatment of two-wall intrabony periodontal defects: A randomized clinical trial. J Dent Res Dent Clin Dent Prospects 2019; 13:51-56. [PMID: 31217919 PMCID: PMC6571513 DOI: 10.15171/joddd.2019.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 01/15/2019] [Indexed: 11/11/2022] Open
Abstract
Background. The ultimate aim of periodontal treatment is to regenerate periodontium and regenerative treatment after that. The aim of this study was to evaluate the effect of PRGF with 1% metformin biofilm in the treatment of two-wall intrabony periodontal defects.
Methods. In this clinical trial, 8 patients with moderate chronic periodontitis and two-wall intrabony defect were selected. The defects were assigned to 4 groups: debridement, 1% metformin, PRGF, PRGF and metformin. The parameters of vertical probing depth, vertical clinical attachment level and gingival index were measured at baseline, immediately before surgery, and 3 and 6 months after surgery. In addition, the radiographic changes were evaluated with digital subtraction radiography before and 6 months after surgery. Analysis of the results was performed with repeated measurements, Friedman test and chisquared test.
Results. All the groups exhibited improvements in all the clinical parameters after 6 months. Inter-group comparison of GI, CAL and PPD parameters revealed no statistically significant differences. Radiographic changes in the group of 1% metformin with PRGF revealed statistically significant differences compared with other groups; however, there were no statistically significant differences in other groups.
Conclusion. Application of PRGF with 1% metformin in intrabony two-wall periodontal defects was effective in improving the clinical parameters but this effect revealed no difference compared with other groups; however, in terms of radiographic changes significant improvements were noted
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Affiliation(s)
| | - Sina Haghanifar
- Oral Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Niloofar Jenabian
- Dental Materials Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Sohrab Kazemi
- Cellular and Molecular Biology Research Center Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mahmoud Hajiahmadi
- Department Biostatistics and Epidemiology, Babol University of Medical Sciences, Babol, Iran
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19
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Wang S, Xia Y, Ma T, Weir MD, Ren K, Reynolds MA, Shu Y, Cheng L, Schneider A, Xu HHK. Novel metformin-containing resin promotes odontogenic differentiation and mineral synthesis of dental pulp stem cells. Drug Deliv Transl Res 2019; 9:85-96. [PMID: 30465181 DOI: 10.1007/s13346-018-00600-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This represents the first report on the development of metformin-containing dental resins. The objectives were to use the resin as a carrier to deliver metformin locally to stimulate dental cells for dental tissue regeneration and to investigate the effects on odontogenic differentiation of dental pulp stem cells (DPSCs) and mineral synthesis. Metformin was incorporated into a resin at 20% by mass as a model system. DPSC proliferation attaching on resins was evaluated. Dentin sialophosphoprotein (DSPP), dentin matrix phosphoprotein 1 (DMP-1), alkaline phosphatase (ALP), and runt-related transcription factor 2 (Runx2) genes expressions were measured. ALP activity and alizarin red staining (ARS) of mineral synthesis by the DPSCs on resins were determined. DPSCs on metformin-containing resin proliferated well (mean ± SD; n = 6), and the number of cells increased by 4-fold from 1 to 14 days (p > 0.1). DSPP, ALP, and DMP-1 gene expressions of DPSCs on metformin resin were much higher than DPSCs on control resin without metformin (p < 0.05). ALP activity of metformin group was 70% higher than that without metformin at 14 days (p < 0.05). Mineral synthesis by DPSCs on metformin-containing resin at 21 days was 9-fold that without metformin (p < 0.05). A novel metformin-containing resin was developed, achieving substantial enhancement of odontoblastic differentiation of DPSCs and greater mineral synthesis. The metformin resin is promising for deep cavities and perforated cavities to stimulate DPSCs for tertiary dentin formation, for tooth root coatings with metformin release for periodontal regeneration, and for root canal fillings with apical lesions to stimulate bone regeneration.
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Affiliation(s)
- Suping Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral, Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.,Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA
| | - Yang Xia
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA.,Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University, Nanjing, 210029, China
| | - Tao Ma
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA
| | - Michael D Weir
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA
| | - Ke Ren
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA
| | - Mark A Reynolds
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA
| | - Yan Shu
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Maryland, Baltimore, MD, 21201, USA.,Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Lei Cheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral, Diseases, Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China. .,Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA.
| | - Abraham Schneider
- Department of Oncology and Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA. .,Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
| | - Hockin H K Xu
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, 21201, USA. .,Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, 21201, USA. .,Center for Stem Cell Biology & Regenerative Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
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20
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Kalaitzoglou E, Fowlkes JL, Popescu I, Thrailkill KM. Diabetes pharmacotherapy and effects on the musculoskeletal system. Diabetes Metab Res Rev 2019; 35:e3100. [PMID: 30467957 PMCID: PMC6358500 DOI: 10.1002/dmrr.3100] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 12/13/2022]
Abstract
Persons with type 1 or type 2 diabetes have a significantly higher fracture risk than age-matched persons without diabetes, attributed to disease-specific deficits in the microarchitecture and material properties of bone tissue. Therefore, independent effects of diabetes drugs on skeletal integrity are vitally important. Studies of incretin-based therapies have shown divergent effects of different agents on fracture risk, including detrimental, beneficial, and neutral effects. The sulfonylurea class of drugs, owing to its hypoglycemic potential, is thought to amplify the risk of fall-related fractures, particularly in the elderly. Other agents such as the biguanides may, in fact, be osteo-anabolic. In contrast, despite similarly expected anabolic properties of insulin, data suggests that insulin pharmacotherapy itself, particularly in type 2 diabetes, may be a risk factor for fracture, negatively associated with determinants of bone quality and bone strength. Finally, sodium-dependent glucose co-transporter 2 inhibitors have been associated with an increased risk of atypical fractures in select populations, and possibly with an increase in lower extremity amputation with specific SGLT2I drugs. The role of skeletal muscle, as a potential mediator and determinant of bone quality, is also a relevant area of exploration. Currently, data regarding the impact of glucose lowering medications on diabetes-related muscle atrophy is more limited, although preclinical studies suggest that various hypoglycemic agents may have either aggravating (sulfonylureas, glinides) or repairing (thiazolidinediones, biguanides, incretins) effects on skeletal muscle atrophy, thereby influencing bone quality. Hence, the therapeutic efficacy of each hypoglycemic agent must also be evaluated in light of its impact, alone or in combination, on musculoskeletal health, when determining an individualized treatment approach. Moreover, the effect of newer medications (potentially seeking expanded clinical indication into the pediatric age range) on the growing skeleton is largely unknown. Herein, we review the available literature regarding effects of diabetes pharmacotherapy, by drug class and/or by clinical indication, on the musculoskeletal health of persons with diabetes.
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Affiliation(s)
- Evangelia Kalaitzoglou
- University of Kentucky Barnstable Brown Diabetes Center Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, USA
| | - John L Fowlkes
- University of Kentucky Barnstable Brown Diabetes Center Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Iuliana Popescu
- University of Kentucky Barnstable Brown Diabetes Center Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Kathryn M Thrailkill
- University of Kentucky Barnstable Brown Diabetes Center Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, USA
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Nicolini AC, Grisa TA, Muniz FWMG, Rösing CK, Cavagni J. Effect of adjuvant use of metformin on periodontal treatment: a systematic review and meta-analysis. Clin Oral Investig 2018; 23:2659-2666. [DOI: 10.1007/s00784-018-2666-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/25/2018] [Indexed: 12/13/2022]
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Najeeb S, Zafar MS, Khurshid Z, Zohaib S, Madathil SA, Mali M, Almas K. Efficacy of metformin in the management of periodontitis: A systematic review and meta-analysis. Saudi Pharm J 2018; 26:634-642. [PMID: 29991907 PMCID: PMC6035318 DOI: 10.1016/j.jsps.2018.02.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/15/2018] [Indexed: 12/22/2022] Open
Abstract
Periodontitis is characterized by inflammation of the periodontium and leads to loss of teeth if untreated. Although a number of surgical and pharmacological options are available for the management of periodontitis, it still affects a large proportion of population. Recently, metformin (MF), an oral hypoglycemic, has been used to treat periodontitis. The aim of this review is to systematically evaluate the efficacy of MF in the treatment of periodontitis. An electronic search was carried out using the keywords 'metformin', 'periodontal' and 'periodontitis' via the PubMed/Medline, ISI Web of Science and Google Scholar databases for relevant articles published from 1949 to 2016. The addressed focused question was: 'Is metformin effective in reducing bone loss in periodontitis? Critical review and meta-analysis were conducted of the results obtained in the selected studies. Following the removal of the duplicate results, the primary search resulted in 17 articles and seven articles were excluded based on title and abstract. Hence, 10 articles were read completely for eligibility. After exclusion of four irrelevant studies, six articles were included. The topical application of MF resulted in improved histological, clinical and radiographic outcomes. Additionally, results from the meta-analysis indicated that application of metformin improved the clinical and radiographic outcomes of scaling and root-planing, but at the same time heterogeneity was evident among the results. However, because of a lack of histological and bacterial studies, in addition to short follow-up periods and risk of bias, the long-term efficacy of MF in the treatment of bony defects is not yet ascertained. Further studies are needed to envisage the long-term efficacy of MF in the management of periodontitis.
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Affiliation(s)
- Shariq Najeeb
- Restorative Dental Sciences, Al-Farabi Colleges, King Abdullah Road, Riyadh, Saudi Arabia
| | - Muhammad Sohail Zafar
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Madinah Al Munawwarah, Saudi Arabia
- Department of Dental Materials, Islamic International Dental College, Riphah International University, Islamabad, Pakistan
| | - Zohaib Khurshid
- Department of Biomaterials and Prosthodontics, College of Dentistry, King Faisal University, Al Hofuf, Saudi Arabia
| | - Sana Zohaib
- Department of Biomedical Engineering, School of Engineering, King Faisal University, Al Hofuf, Saudi Arabia
| | - Sreenath Arekunnath Madathil
- Division of Oral Health and Society Research, Faculty of Dentistry, McGill University, 2001 McGill College Ave, Montreal, Quebec, Canada
| | - Maria Mali
- Department of Orthodontics, Islamic International Dental College, Ripah International University, Islamabad 44000, Pakistan
| | - Khalid Almas
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Akram Z, Vohra F, Javed F. Locally delivered metformin as adjunct to scaling and root planing in the treatment of periodontal defects: A systematic review and meta-analysis. J Periodontal Res 2018; 53:941-949. [DOI: 10.1111/jre.12573] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Z. Akram
- Department of Periodontology; Faculty of Dentistry; Ziauddin University; Karachi Pakistan
| | - F. Vohra
- Department of Prosthetic Dental Sciences; College of Dentistry; King Saud University; Riyadh Saudi Arabia
| | - F. Javed
- Department of General Dentistry; Eastman Institute for Oral Health; University of Rochester; Rochester NY USA
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Khajuria DK, Patil ON, Karasik D, Razdan R. Development and evaluation of novel biodegradable chitosan based metformin intrapocket dental film for the management of periodontitis and alveolar bone loss in a rat model. Arch Oral Biol 2017; 85:120-129. [PMID: 29055230 DOI: 10.1016/j.archoralbio.2017.10.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of this study was to develop a chitosan-metformin based intrapocket dental film (CMIDF) for applications in the treatment of periodontitis and alveolar bone loss in an rat model of periodontitis. DESIGN CMIDF inserts were fabricated by the solvent casting technique. The fabricated inserts were evaluated for physical characteristics such as folding endurance, surface pH, mucoadhesive strength, metformin content uniformity, and release. X-ray diffraction analysis indicates no crystallinity of metformin in presence of chitosan which confirmed successful entrapment of metformin into the CMIDF. Fourier-transform infrared spectroscopy revealed stability of CMIDF and compatibility between metformin and chitosan. Periodontitis was induced by a combination of Porphyromonas gingivalis- lipopolysaccharide injections in combinations with ligatures around the mandibular first molar. We divided rats into 5 groups (8 rats/group): healthy, untreated periodontitis; periodontitis plus CMIDF-A (1.99±0.09mg metformin; total mass-4.01±0.05mg), periodontitis plus CMIDF-B (2.07±0.06mg metformin; total mass-7.56±0.09mg), and periodontitis plus chitosan film (7.61±0.08mg). After four weeks, mandibles were extracted to evaluate alveolar bone loss by micro-computerized tomography and histological techniques. RESULTS Alveolar bone was intact in the healthy group. Local administration of CMIDF resulted in significant improvements in the alveolar bone properties when compared to the untreated periodontitis group. The study reported here demonstrates that novel CMIDF showed good antibacterial activity and effectively reduced alveolar bone destruction in a rat model of experimental periodontitis. CONCLUSIONS Novel CMIDF showed good antibacterial activity and improved alveolar bone properties in a rat model.
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Affiliation(s)
- Deepak Kumar Khajuria
- The Musculoskeletal Genetics Laboratory, Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel; Department of Pharmacology, Al-Ameen College of Pharmacy, Bangalore, India.
| | | | - David Karasik
- The Musculoskeletal Genetics Laboratory, Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Rema Razdan
- Department of Pharmacology, Al-Ameen College of Pharmacy, Bangalore, India
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Sharma A, Raman A, Pradeep AR. Role of 1% alendronate gel as adjunct to mechanical therapy in the treatment of chronic periodontitis among smokers. J Appl Oral Sci 2017; 25:243-249. [PMID: 28678942 PMCID: PMC5482246 DOI: 10.1590/1678-7757-2016-0201] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/22/2016] [Indexed: 02/06/2023] Open
Abstract
Objective Alendronate (ALN) inhibits osteoclastic bone resorption and triggers osteostimulative properties both in vivo and in vitro, as shown by increase in matrix formation. This study aimed to explore the efficacy of 1% ALN gel as local drug delivery (LDD) in adjunct to scaling and root planing (SRP) for the treatment of chronic periodontitis among smokers. Material and Methods 75 intrabony defects were treated in 46 male smokers either with 1% ALN gel or placebo gel. ALN gel was prepared by adding ALN into carbopol-distilled water mixture. Clinical parameters [modified sulcus bleeding index, plaque index, probing depth (PD), and periodontal attachment level (PAL)] were recorded at baseline, at 2 months, and at 6 months, while radiographic parameters were recorded at baseline and at 6 months. Defect fill at baseline and at 6 months was calculated on standardized radiographs by using the image analysis software. Results Mean PD reduction and mean PAL gain were found to be greater in the ALN group than in the placebo group, both at 2 and 6 months. Furthermore, a significantly greater mean percentage of bone fill was found in the ALN group (41.05±11.40%) compared to the placebo group (2.5±0.93%). Conclusions The results of this study showed 1% ALN stimulated a significant increase in PD reduction, PAL gain, and an improved bone fill compared to placebo gel in chronic periodontitis among smokers. Thus, 1% ALN, along with SRP, is effective in the treatment of chronic periodontitis in smokers.
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Affiliation(s)
| | | | - Avani Raju Pradeep
- Government Dental College and Research Institute, Department of Periodontics, Bangalore, Karnataka, India
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Dutra BC, Oliveira AMSD, Oliveira PAD, Manzi FR, Cortelli SC, Cota LODM, Costa FO. Effect of 1% sodium alendronate in the non-surgical treatment of periodontal intraosseous defects: a 6-month clinical trial. J Appl Oral Sci 2017; 25:310-317. [PMID: 28678950 PMCID: PMC5482254 DOI: 10.1590/1678-7757-2016-0252] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 12/06/2016] [Indexed: 12/04/2022] Open
Abstract
Background and objectives Few studies have evaluated the effect of the topical application of sodium alendronate (ALN) on the treatment of intrabuccal bone defects, especially those caused by periodontitis. This 6-month randomized placebo controlled clinical trial aimed at evaluating the effect of non-surgical periodontal treatment associated with the use of 1% ALN, through clinical evaluations and cone-beam computed tomography (CBCT). Material and Methods Twenty individuals with chronic periodontitis underwent periodontal examination at the baseline as well as 3 and 6 months after periodontal treatment, registering clinical attachment level (CAL), periodontal probing depth (PPD), and bleeding on probing (BOP) as the clinical outcomes. After manual scaling and root planing, 40 bilateral sites with interproximal vertical bone defects were randomly treated with either 1% ALN gel or a placebo. Bone defects were evaluated through CBCT at the baseline and 6 months post-treatment. The clinical and CBCT parameters were compared using the Wilcoxon and Friedman tests (p<0.05). Results Although ALN produced a greater CAL gain when compared to the placebo at 6 months post-treatment (p=0.021), both treatments produced similar effects on the PPD, BOP, and bone height. Significant differences in bone fill were observed only in patients of the ALN group (4.5 to 3.8 mm; p=0.003) at 6 months post-treatment. Conclusions Topical application of 1% ALN might be a beneficial adjuvant to non-surgical periodontal therapy.
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Affiliation(s)
- Bernardo Carvalho Dutra
- Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Patologia e Cirurgia. Belo Horizonte, MG, Brasil
| | | | | | - Flavio Ricardo Manzi
- Pontífica Universidade Católica of Minas Gerais, Departamento de Periodontia. Belo Horizonte, MG, Brasil
| | - Sheila Cavalca Cortelli
- Universidade de Taubaté, Departamento de Odontologia, Divisão de Pesquisa Periodontal. Taubaté, SP, Brasil
| | - Luís Otávio de Miranda Cota
- Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Patologia e Cirurgia. Belo Horizonte, MG, Brasil
| | - Fernando Oliveira Costa
- Universidade Federal de Minas Gerais, Faculdade de Odontologia, Departamento de Patologia e Cirurgia. Belo Horizonte, MG, Brasil
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Wang P, Ma T, Guo D, Hu K, Shu Y, Xu HHK, Schneider A. Metformin induces osteoblastic differentiation of human induced pluripotent stem cell-derived mesenchymal stem cells. J Tissue Eng Regen Med 2017; 12:437-446. [PMID: 28494141 DOI: 10.1002/term.2470] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/12/2017] [Accepted: 05/04/2017] [Indexed: 12/14/2022]
Abstract
Metformin, a first-line antidiabetic drug used by millions of patients, has been shown to have potential osteogenic properties. The present study was performed to test the hypothesis that clinically relevant doses of metformin promote the osteogenic differentiation and mineralization of induced pluripotent stem cell-derived mesenchymal stem cells (iPSC-MSCs). iPSC-MSCs were treated with metformin (10 μm) to assess cell viability, osteogenic differentiation, mineralization and activation of the LKB1/AMP-activated protein kinase (AMPK) signalling pathway, a surrogate marker of metformin action. To determine its potential application in MSC-based bone and periodontal tissue engineering, iPSC-MSCs were also treated with metformin when seeded on to calcium phosphate cement (CPC) scaffolds. Immunoblotting and cellular uptake assays showed that iPSC-MSCs express functional organic cation transporter-1 (OCT-1), a transmembrane protein that mediates the intracellular uptake of metformin. Although metformin treatment did not impair iPSC-MSC viability, it significantly stimulated alkaline phosphatase activity, enhanced mineralized nodule formation and increased expression of osteogenic markers, including Runt-related transcription factor 2 (RUNX2) and osterix. Inhibition of LKB1 activity, a common upstream AMPK kinase, markedly reversed metformin-induced AMPK activation, RUNX2 expression and nuclear localization. Moreover, metformin substantially increased mineralized nodule formation of iPSC-MSC seeded on CPC scaffolds. Collectively, functional OCT-expressing iPSC-MSCs responded to metformin by inducing an osteogenic effect in part mediated by the LKB1/AMPK pathway. Considering the widespread use of metformin in diabetics, this work may lead to novel tissue-engineering platforms where autogenous OCT-expressing iPSC-MSCs might be used to enhance bone and periodontal regeneration in diabetic patients prescribed with daily doses of metformin.
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Affiliation(s)
- Ping Wang
- Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - Tao Ma
- Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - Dong Guo
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Maryland, Baltimore, MD, USA
| | - Kevin Hu
- Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - Yan Shu
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Maryland, Baltimore, MD, USA
| | - Hockin H K Xu
- Department of Endodontics, Periodontics and Prosthodontics, School of Dentistry, University of Maryland, Baltimore, MD, USA
| | - Abraham Schneider
- Department of Oncology and Diagnostic Sciences, School of Dentistry, University of Maryland, Baltimore, MD, USA
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