Role of 1% alendronate gel as adjunct to mechanical therapy in the treatment of chronic periodontitis among smokers

Comparative evaluation of the clinical and radiographic efficacy of 0.05% zoledronate gel as local drug delivery system in treating intrabony defects in stage III grade B periodontitis patients with and without type-2 diabetes mellitus-A randomized split-mouth clinical trial

BACKGROUND

This 6-month randomized split-mouth and placebo-controlled clinical trial aimed to evaluate the clinical and radiographic efficacy of adjunctive use of 0.05% zoledronate (ZLN) gel as local drug delivery to scaling and root planing (SRP) in stage III, grade B periodontitis patients with and without controlled type-2 diabetes mellitus (DM).

METHODS

A total of 120 infrabony sites were divided into two groups: Group-1 (non-diabetic periodontitis) and Group-2 (periodontitis + DM). A total of 60 sites in each group were randomized to receive treatment with SRP + placebo gel (control) or SRP + 0.05% ZLN gel (test). Plaque index (PI), modified sulcus bleeding index (mSBI), pocket probing depth (PPD), and relative attachment levels (RAL) were assessed at baseline, 3 and 6 months, and digital intraoral periapical and cone-beam computed tomography imaging were used to measure the linear and percentage reduction of intrabony defect depth (DD, DDR%) after 6 months.

RESULTS

Group-1 showed significant reduction in PI (0.56 ± 0.15 and 0.52 ± 0.19 from 0.67 ± 0.17), mSBI (0.7 ± 0.60 and 0.47 ± 0.57 from 0.9 ± 0.48), PPD (4.6 ± 0.85 and 3.43 ± 0.63 from 6.5 ± 1.04) and gain in RAL (7.03 ± 0.85 and 5.93 ± 0.69 from 8.9 ± 1.09) in the ZLN-treated sites than the placebo sites and also from Group-2 sites after 3 and 6 months, respectively. A significant reduction in DD of 28.79% in Group-1 and 22.20% in Group-2 at ZLN sites was seen compared to placebo sites of both groups.

CONCLUSION

ZLN gel applied subgingivally in infrabony pockets resulted in significant clinical improvements evident by probing depth reduction and gain in attachment levels along with radiographic evidence of more bone fill seen in non-diabetic patients compared to diabetic periodontitis patients.

Sodium alendronate is an effective adjunctive therapy for treating periodontitis in male rats treated with anticancer chemotherapy

OBJECTIVES

To assess sodium alendronate as a local adjunctive therapy for treating experimental periodontitis in male rats treated with chemotherapy.

DESIGN

One-hundred-eighty male rats were randomly divided into two groups (n = 90) based on the systemic treatments: PSS, physiological saline solution; and 5-Fluorouracil, and then, subdivided into three subgroups (n = 30): NT, no treatment; scaling and root planing; and sodium alendronate. Treatments were performed 7 days after induction of experimental periodontitis. Specimens were collected at 14, 22, and 37 days after induction. Alveolar bone level, percentage of bone in the furcation, percentage of non-vital bone in the furcation, histopathologic features, and immunolabeling pattern for tartrate-resistant acid phosphatase (TRAP) and osteocalcin (OCN) were evaluated.

RESULTS

The lowest amount of alveolar bone and highest amount of non-vital bone was found in group 5-Fluorouracil when no treatment was performed. In animals receiving 5-Flurouracil and subjected to periodontal treatment, adjunctive sodium alendronate resulted in higher percentage of bone in the furcation and higher alveolar bone loss, when compared with scaling and root planing alone. Better structural and cellularity patterns were found in the periodontal tissues when sodium alendronate was used, regardless of systemic treatment. Higher TRAP-expression was found when no treatment was performed. Sodium alendronate didn't affect the immunolabeling pattern of osteocalcin in the presence of 5-Fluorouracil.

CONCLUSION

Adjunctive therapy with local sodium alendronate prevented alveolar bone loss and improved the histopathological features of the periodontal tissues following scaling and root planing in male rats with experimental periodontitis receiving anticancer chemotherapy with 5-Fluorouracil.

Gels as adjuvant to non-surgical periodontal therapy: A systematic review and meta-analysis

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.

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

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.

Added effect of 1% topical alendronate in intra-bony and inter-radicular defects as part of step II periodontal therapy: a systematic review with meta-analysis and trial sequential analysis

Background

This systematic review and meta-analysis aimed to investigate the role of alendronate combined with step 2 of periodontal therapy in reducing probing pocket depth, improving clinical attachment level, and reducing bone defect depth in intra-bony and inter-radicular defects.

Methods

RCTs with more than 6 months follow-up were included in this study. Risk of bias assessment was performed using the Cochrane collaboration tool. In addition, meta-analysis and trial sequential analysis were used to aggregate the available evidence.

Results

Seven studies met the inclusion criteria and were included in the systematic review. Topical application of alendronate during second step of periodontal therapy significantly improved PD and CAL.

Conclusion

Local application of alendronate may confer a beneficial effect when applied during step II of periodontal therapy even if long term studies are needed to confirm these results.

Clinical relevance

Considering the emerging role of host-inflammatory response in treatment of periodontitis and the antiresorptive and osteostimulative properties of bisphosphonates, several studies are focusing on the role of alendronate as an addition to non-surgical periodontal therapy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02044-1.

Adjuvant therapy with 1% alendronate gel for experimental periodontitis treatment in rats

Purpose

The aim of this study was to evaluate the effects of locally delivered 1% alendronate (ALN) gel used as an adjunct to non-invasive periodontal therapy.

Methods

Ligature-induced periodontitis was performed in 96 rats. The ligature was tied in the cervical area of the mandibular left first molar. The animals were randomly divided into 4 groups: 1) NT, no treatment; 2) SRP, scaling and root planning; 3) SRP/PLA, SRP followed by filling the periodontal pocket with placebo gel (PLA); and 4) SRP/ALN, SRP followed by filling the periodontal pockets with 1% ALN gel. Histomorphometric (percentage of bone in the furcation region [PBF]) and immunohistochemical (receptor activator of nuclear factor-κB ligand, osteoprotegerin, and tartrate-resistant acid phosphatase) analyses were performed. Data were statistically analyzed, with the threshold of statistical significance set at P≤0.05.

Results

The SRP, SRP/PLA, and SRP/ALN groups presented a higher PBF than the NT group (P≤0.01) at 7, 15, and 30 days. The SRP/ALN group presented a higher PBF than the SRP/PLA group in all experimental periods, as well as a higher PBF than the SRP group at 15 and 30 days. No differences were observed in the immunohistochemical analyses (P>0.05 for all).

Conclusions

Locally delivered 1% ALN gel used as an adjunct to SRP enhanced bone regeneration in the furcation region in a rat model of experimental periodontitis.

Efficacy of Oregano Essential Oil Extract in the Inhibition of Bacterial Lipopolysaccharide (LPS)-Induced Osteoclastogenesis Using RAW 264.7 Murine Macrophage Cell Line—An In-Vitro Study

Gram-negative, anaerobic bacterias are predominate in periapical infections. The bacterial lipopolysaccharide (LPS) initiates the process of inflammation and periapical bone resorption. Usage of various medicaments retards or inactivates the bacterial endotoxin (LPS). However, the results are not highly effective. In recent years, owing to antimicrobial resistance, the shift from conventional agents to herbal agents has been increased tremendously in research. Keeping this in mind, the present study was formulated to evaluate the efficacy of oregano essential oil in inhibiting bacterial LPS- induced osteoclastogenesis. Four different concentrations (0 ng/mL, 25 ng/mL, 50 ng/mL, and 100 ng/mL) of oregano essential oil extract were added into 96-well culture plate. Under light microscope, quantification of osteoclast cells was performed. One-way ANOVA with post-hoc Tukey test was carried out on SPSS v21. A significant reduction (p < 0.001) in the osteoclast was observed in the experimental groups compared to no oregano essential oil extract (control). A dose-dependent significant reduction (p < 0.001) in osteoclast formation was observed among the experimental groups, with lesser osteoclast seen in group IV with 100 ng/mL of oregano essential oil extract. Thus, it can be concluded that oregano essential oil extract can be utilized as a therapeutic agent that can target bacterial LPS-induced osteoclastogenesis. However, randomized controlled studies should be conducted to assess the potential use of this extract in the periapical bone resorption of endodontic origin.

Unusual Findings in Trials Evaluating Adjuncts to Scaling and Root Planing: Meta-analysis (Part 1)

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.

EFFECT OF LOCALLY DELIVERED BISPHOSPHONATES ON ALVEOLAR BONE: A SYSTEMATIC REVIEW AND META-ANALYSIS

OBJECTIVE

To assess the effect of locally applied bisphosphonate drugs on alveolar bone defects caused by periodontitis and marginal bone level after placement of dental implants.

MATERIALS AND METHODS

Three electronic databases (PubMed/MEDLINE, Web of Science, and Scopus) were searched from January 2010 until May 2020 for randomized controlled clinical trials reporting the effect of locally delivered bisphosphonates on alveolar bone. The risk of bias was assessed and quantitative synthesis was conducted with both fixed and random-effects meta-analyses by using RevMan version 5.3. Subgroup and sensitivity analyses were performed whenever required.

RESULTS

Among the included studies, the effect of locally delivered bisphosphonates on alveolar bone regeneration in periodontitis was measured by 15 studies and on marginal bone level after installation of dental implants by three studies. Bisphosphonates showed significantly higher intrabony defect depth reduction than placebo/control in vertical bone defects treated with non-surgical approach (MD = 1.69mm; 95% CI, 1.32-2.05; P < 0.00001; I²=93%) or surgical approach (MD = 0.70mm; 95% CI, 0.23-1.16; P = 0.003; I² = 78%) and in class II furcation defects treated with non-surgical approach (MD = 1.61mm; 95% CI, 1.15-2.07; P < 0.00001; I² = 99%) or surgical approach (MD = 0.24mm; 95% CI, 0.05-0.42; P = 0.01; I² = 62%). Clinical attachment loss increased by 1.39mm (95% CI, 0.92-1.85; P < 0.01; I²=93%) and 1mm (95% CI, 0.75-1.26; P < 0.001; I² = 0%) in vertical bone defects after non-surgical and surgical treatments, respectively, and by 1.95mm (95% CI, 1.37-2.53; P < 0.00001; I² = 96%) and 0.84mm (95% CI, 0.58-1.10; P < 0.01, I² = 47%) after non-surgical and surgical treatment in class II furcation defects, respectively. Lesser marginal bone loss during pre-loading (MD = -0.18 mm; 95% CI, -0.24- -0.12; P<0.00001; I²=0%) and 1-year post-loading (MD = -0.33 mm; 95% CI, -0.59-0.07; P = 0.01; I² = 0%) periods was observed when bisphosphonate coated dental implants were used.

CONCLUSION

Locally delivered bisphosphonates induce bone regeneration in periodontal defects and decrease the rate of marginal bone loss after dental implant therapy.

Bisphosphonates in Dentistry – State of the Art

Bisphosphonates remain the most used and most effective drugs for the treatment of systemic bone diseases followed by bone resorption. Although their side effects in a form of alveolar bone osteonecrosis have been reported, bisphosphonates have a potential of being used in the treatment of the most common oral diseases followed by alveolar bone resorption such as peri-implantitis, periapical lesions, and periodontitis. The aim of this article was to review the most recent research regarding the use of bisphosphonates in the field of dentistry. The results of studies indicate that bisphosphonate use in the treatment of peri-implantitis, periapical lesions, and periodontitis can reduce alveolar bone resorption and contribute to bone preservation. However, the most beneficial way of their application in the treatment of these oral diseases remain to be determined.

The adjunctive use of host modulators in non-surgical periodontal therapy. A systematic review of randomized, placebo-controlled clinical studies

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.

Effect of adjuvant bisphosphonates on treatment of periodontitis: Systematic review with meta-analyses

Background

Previous systematic reviews showed additional benefit of adjuvant bisphosphonates (BP) in the treatment of periodontitis. In contrast, it is unclear the effect of BP in patients with diabetes and smokers, its pooled effect when administered locally or systemically is also unknown.

Objectives

This study aimed to systematically review the literature about the use of BP as adjuvant to nonsurgical scaling and root planning (SRP).

Methodology

This study followed the PRISMA guideline. This study included randomized clinical trials that administered locally or systemically BPs as adjuvant for periodontal treatment. Five databases were used. Meta-analyses were performed, using the pooled mean differences (MD) for clinical attachment level (CAL) and probing pocket depth (PPD). Standard mean difference (SMD) was used for radiographic assessment (RADIO). Subgroup analyses were performed for locally delivered meta-analyses, considering diabetes and smoking exposure.

Results

Thirteen studies were included. It was showed MD of 1.52 ​mm (95%CI: 0.97-2.07) and 1.44 ​mm (95%CI: 1.08-1.79) for PPD reduction and CAL gain, respectively, for locally delivered BP. BP was not able to provide significant improvements in smokers (subgroup analysis) when considering CAL (MD: 1.37; 95%CI: -0.17-2.91) and PPD (MD: 1.35; 95%CI: -0.13-2.83). Locally delivered BP also improved significantly the RADIO assessments (SMD: 4.34; 95%CI: 2.94-5.74). MD for systemically administered BP was 0.40 ​mm (95%CI: 0.21-0.60), 0.51 ​mm (95%CI: 0.19-0.83) and 1.05 (95%CI: 0.80-1.31) for PPD, CAL and RADIO, respectively.

Conclusion

The administration of BP in adjunct to SRP may result in additional clinical effects.

Bisphosphonates as Supplement to Dental Treatment: A Network Meta-Analysis

The objective of this study was to assess clinical measurements related to the effectiveness of bisphosphonate (BP) administration as a supplement to conventional dental treatment in patients free of bone-related diseases using a network meta-analysis. Only randomized controlled trials (RCTs) were included that provided dental clinical measurements on human patients treated with BPs with or without similar untreated controls or treated with placebo. Information sources included a systematic search of 17 electronic databases up to August 2020, complemented by manual searches. Risk of bias assessment was performed with the revised Cochrane risk of bias tool for randomized trials (RoB 2.0). Extracted measurements were pooled according to time of evaluation. The random-effects model by DerSimonian and Laird was used to calculate mean differences (MDs) and the respective 95% confidence intervals (CIs). Seven RCTs were included in the network meta-analysis, assessing 391 subjects reporting on periodontal treatment effects after 2 to 12 mo of BP administration. BP treatment was associated with significant improvement of most clinical measurements, compared with BP-naive controls. According to the network ranking, alendronate was more efficient in improvement of probing depth and clinical attachment gain when compared to zoledronate or alendronate/risedronate. Similarly, the local application of alendronate as a gel was more effective than the oral administration. A long-term analysis of the pharmaceutical effects was not possible due to insufficient data. The current review, performed according to existing guidelines, included only RCTs and, through appropriate statistical analyses, provided precise estimates for most assessed outcomes. However, no adverse effects or long-term treatment results were analyzed due to inadequate pertinent data. BP administration seems to be beneficial in the short term for the treatment of periodontal diseases, mainly through controlling periodontal inflammation.

Effect of probiotics as a complement to non-surgical periodontal therapy in chronic periodontitis: a systematic review

BACKGROUND

To improve the results of the classic periodontal treatment, probiotics have been suggested recently to decrease the number of bacteria and the expression of mediators of inflammation. This systematic review aimed to assess the literature for the effectiveness of different probiotic strains as adjuvants to non-surgical periodontal therapy.

MATERIAL AND METHODS

The electronic database of MEDLINE (via Pubmed) was searched up to December 2017 for randomised clinical trials in English comparing non-surgical periodontal treatment and probiotics versus periodontal treatment and placebo. The primary outcome investigated was reduction in pocket probing depth. Secondary outcomes were bleeding on probing, plaque index reduction and bacteria counts.

RESULTS

Nine trials were included. A narrative data synthesis did not result in any major improvement of overall pocket probing depth but moderate pockets from 4 to 6 mm showed larger reductions in study groups, which could decrease the need for surgery. Sites with bleeding on probing and presence of plaque decreased after treatment. For periimplant mucositis, there was a small tendency to better results in the study group.

CONCLUSIONS

With the available data, it is concluded that probiotics may provide an additional benefit to manual debridement in chronic periodontitis. More studies are required on dose, route of administration and strains of probiotics used.

Synergistic Application of Platelet-Rich Fibrin and 1% Alendronate in Periodontal Bone Regeneration: A Meta-Analysis

Periodontal bone regeneration relies on coupled and cooperative bone formation and resorption. Accordingly a novel strategy on concurrent use of platelet-rich fibrin (PRF) (anabolic agent) and 1% alendronate (ALN) (anticatabolic agent) was proposed recently in regenerative periodontal treatment. It was supposed to enhance bone formation and reduce bone resorption simultaneously. However, there is a lack of evidence-based studies to answer whether this concurrent application was superior to single application until now. Besides, concerns on ALN lead to some reservation on this synergistic way. ALN may impair new bone formation and necrotize jaws. Thus, in order to compare the clinical efficacy between PRF plus 1%ALN and PRF alone on periodontal bone regeneration, we performed present systematic review and meta-analysis. Because it is the prerequisite for measuring the combined efficacy of PRF plus 1%ALN, firstly we evaluated the effectiveness of 1%ALN. Our data indicated that adjunctive 1%ALN was effective in promoting periodontal bone repair. Further, PRF plus 1%ALN showed a greater capacity for periodontal regeneration than PRF alone with statistical significance. The findings of this study revealed the promising prospects on synergistic application of bone anabolic agents (PRF) and antiresorption medications (1%ALN) in regenerative periodontal treatment.

Local drug delivery systems in the management of periodontitis: A scientific review

Periodontitis (PD) is a microbial disease of tooth supporting tissues that results in progressive destruction of surrounding soft and hard tissues with eventual tooth mobility and exfoliation. Perioceutics, which includes the delivery of therapeutic agents via systemic and local means as an adjunct to mechanical therapy has revolutionized the arena of periodontal therapy. Selection of a right antimicrobial agent with appropriate route of drug administration is the key to successful periodontal therapy. Irrigating systems, fibers, gels, strips, films, microparticles, nanoparticles and low dose antimicrobial agents are some of the local drug delivery systems (LDDS) available in the field, which aims to deliver antimicrobial agents to sub-gingival diseased sites with minimal or no side-effects on other body sites. The present review aim to summarize the current state-of-the-art technology on LDDS in periodontal therapy ensuring the the practitioners are able to choose LDD agents which are custom made for a specific clinical condition.

Influence of pH on osteoclasts treated with zoledronate and alendronate

OBJECTIVES

The objectives of this study were to analyze the effect of pH on the growth and activity of osteoclasts treated with different doses of two nitrogen-containing BPs, zoledronate and alendronate.

MATERIALS AND METHODS

Murine osteoclasts cultured on dentine disks were treated with zoledronate (50 or 500 nM) or alendronate (500 or 5 μM) at two different pH values (7.4 or 7.0). Osteoclasts were counted with transmitted light microscopy, apoptosis/necrosis was studied with flow cytometry and confocal microscopy, and resorption pit number and depth were calculated using reflected light and scanning electron microscopy.

RESULTS

The osteoclast count on dentine disks was significantly (p < 0.001) reduced by zoledronate or alendronate treatment at pH 7.0 in comparison to treatment with the same doses at pH 7.4 and untreated disks (controls). The percentage of apoptotic cells was significantly increased by treatment with 500 nM zoledronate or 5 μM alendronate at pH 7.0 in comparison to the same doses at pH 7.4. The number and depth of resorption pits were significantly lower in disks treated at each BP dose studied than in untreated controls at pH 7.0.

CONCLUSIONS

Zoledronate and alendronate at therapeutic doses have an adverse effect on the viability and resorptive activity of osteoclasts when the local medium pH is reduced.

CLINICAL RELEVANCE

These findings suggest that periodontal or peri-implant oral cavity infection may be a key trigger of the cascade of events that lead to BRONJ.

Systematic review and meta-analysis of double-blind, placebo-controlled, randomized clinical trials using probiotics in chronic periodontitis

AIM

The aim of the present study was to evaluate the efficacy of probiotics as an adjunct to scaling and root planning (SRP) in the treatment of chronic periodontitis (CP).

METHODS

The focused question of the study was: Does adjunctive use of probiotics yield better clinical periodontal outcomes compared to placebo/no treatment group in the treatment of CP? Electronic and manual literature searches were conducted up to December 2017 using the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register. Forest plots were computed reporting weighted mean difference (WMD) of outcomes and 95% confidence intervals (CI).

RESULTS

Seven clinical studies were included. Four studies showed additional benefits in reducing periodontal probing depth (PPD) and gaining clinical attachment level (CAL), whereas, three studies showed comparable clinical periodontal outcomes between probiotics and SRP/placebo. Significant heterogeneity was observed for PPD reduction and CAL gain. The overall mean difference for CAL gain between probiotics and placebo/SRP was significant (WMD = 1.41, 95% CI = 0.15-2.67, P = .028) at follow up.

CONCLUSION

Adjunctive probiotics could result in additional benefits in CAL gain in CP. Nevertheless, further high-quality randomized clinical trials with microbiological outcomes are warranted to obtain strong conclusions in this regard.

A randomized controlled clinical trial evaluating the efficacy of zoledronate gel as a local drug delivery system in the treatment of chronic periodontitis: A clinical and radiological correlation

Background

This study aimed to evaluate the efficacy of local drug delivery system of zoledronate (ZLN) gel as an adjunct to scaling and root planing (SRP) for the treatment of human periodontal intrabony defects clinically and radiographically.

Materials and Methods

Forty intrabony defects (three walled and combined defects without involving furcation) in moderate to severely affected forty chronic periodontitis patients (range, 30-50 years) were randomly divided into two groups and treated either with 0.05% ZLN gel (ZLN n = 20; 1 dropout) or placebo gel (control group [CG] n = 20) after SRP. Clinical parameters such as plaque index (PI), gingival index (GI), tooth-specific pocket probing depth (T_s PPD), and clinical attachment levels (TsCAL) were assessed at baseline and at 3 and 6 months using occlusal acrylic stent. Radiographic parameters were assessed at baseline and 6 months, utilizing "ONIS 2.5 PROFESSIONAL" and "SYNGO" software compatible with DentaScan to measure the volumetric bone changes in intrabony defects.

Results

In intragroup comparisons, both groups showed significant PI and GI reduction (P < 0.001) after treatment at 3 and 6 months. In intergroup comparisons, T_s PPD reduction and T_s CAL gain were significant only in ZLN at 6 months from both baseline and 3 months. Radiographically, significant reduction in defect depth and buccolingual width with volumetric defect gain of 40.24% ± 7.44% in ZLN compared to insignificant gain of 1.60% ± 4.06% in CG was observed at 6 months.

Conclusion

ZLN gel applied subgingivally in intrabony defects resulted in significant improvements both clinically and radiographically.