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Greethurst AR, Galletti C, Lo Giudice R, Nart J, Vallés C, Real-Voltas F, Gay-Escoda C, Marchetti E. The Use of Statins as an Adjunctive Periodontal Disease Treatment: Systematic Review and Meta-Analysis. Dent J (Basel) 2024; 12:150. [PMID: 38920851 PMCID: PMC11202911 DOI: 10.3390/dj12060150] [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: 02/19/2024] [Revised: 05/06/2024] [Accepted: 05/11/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND the purpose of this systematic review was to assess the clinical and radiographic effect of subgingival-administered statins as an adjunct periodontal treatment in patients with periodontitis. METHODS Electronic literature searches in Medline/PubMed and the Cochrane Library were conducted to identify all relevant articles. Eligibility was based on inclusion criteria which included Randomized Controlled Trials (RCTs) published after 2010, where the periodontal variables were assessed before and after periodontal treatment in combination with a statin administration. The risk of bias was assessed with the ROBINS-2 tool. The outcome variables were probing depth, clinical attachment level, bleeding on probing, and bone fill in systematically healthy patients, patients with type 2 diabetes, and smokers. RESULTS Out of 119 potentially eligible articles, 18 randomized controlled trials were included with a total of 1171 participants. The data retrieved from the meta-analysis showed the positive effect that statins have as an adjunctive periodontal disease treatment. When comparing the different types of statins, the PD reduction in the Simvastatin group was significantly higher than the Atorvastatin group at 6 months and at 9 months, while no differences between statins were found for the rest of the outcomes. Over 66% of the articles presented an overall risk of bias with some concerns, making this a limitation of this present RCT. CONCLUSIONS The adjunct administration of statins has proven to have a positive effect on the periodontium by improving both clinical and radiographic parameters by a considerable margin.
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Affiliation(s)
- Alice Rose Greethurst
- School of Dentistry, Department of Integrated Dentistry, International University of Catalonia, Sant Cugat del Vallès, 08022 Barcelona, Spain; (A.R.G.); (C.G.); (F.R.-V.)
| | - Cosimo Galletti
- School of Dentistry, Department of Integrated Dentistry, International University of Catalonia, Sant Cugat del Vallès, 08022 Barcelona, Spain; (A.R.G.); (C.G.); (F.R.-V.)
| | - Roberto Lo Giudice
- Department of Human Pathology of Adults and Developmental Age, Messina University, 98100 Messina, Italy
| | - José Nart
- Department of Periodontology, International University of Catalonia, Sant Cugat del Vallès, 08022 Barcelona, Spain; (J.N.); (C.V.)
| | - Cristina Vallés
- Department of Periodontology, International University of Catalonia, Sant Cugat del Vallès, 08022 Barcelona, Spain; (J.N.); (C.V.)
| | - Francisco Real-Voltas
- School of Dentistry, Department of Integrated Dentistry, International University of Catalonia, Sant Cugat del Vallès, 08022 Barcelona, Spain; (A.R.G.); (C.G.); (F.R.-V.)
| | - Cosme Gay-Escoda
- Oral and Maxillofacial Surgery Department, School of Dentistry, University of Barcelona, 08022 Barcelona, Spain;
- Department of Teknon Medical Center, IDIBELL Institute, 08022 Barcelona, Spain
| | - Enrico Marchetti
- Department of Life, Health and Environmental Sciences, University of l’Aquila, Piazzale Salvatore Tommasi 1, 67100 Coppito, Italy;
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Basudan AM, Abas I, Shaheen MY, Alghamdi HS. Effectiveness of Topical Oxygen Therapy in Gingivitis and Periodontitis: Clinical Case Reports and Review of the Literature. J Clin Med 2024; 13:1451. [PMID: 38592268 PMCID: PMC10932006 DOI: 10.3390/jcm13051451] [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: 02/01/2024] [Revised: 02/22/2024] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
Gingivitis and periodontitis are common oral pathological conditions. Several optional adjunctive local therapies are used clinically. While antibiotics and chlorhexidine are the most common agents of choice, their long-term use is associated with several adverse effects. Some of these include staining of teeth and restorations, cellular cytotoxicity and hypersensitivity. Topical oxygen therapy has been recently introduced and could be clinically capable of inhibiting plaque bacterial biofilm growth. Available as a mouthwash, toothpaste and oral gel, this formulation comprises cellulose, glycerol and sodium peroxoborate, and releases topical oxygen in a controlled manner. Moreover, it releases topical oxygen, in a controlled manner, and lactoferrin, which are capable of antibacterial action and stimulation of bone cells, respectively. The aim of this paper is to report a case of gingivitis and another case of periodontitis, both of which were successfully treated clinically with adjunctive local oxygen therapy (blue®m). Additionally, this paper aims to review the relevant literature in terms of adjunct topical or local therapies used in the treatment of gingivitis and periodontitis, in order to understand how local therapies are helpful and to know if local oxygen therapy is a suitable clinical alternative.
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Affiliation(s)
- Amani M. Basudan
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia; (M.Y.S.); (H.S.A.)
| | - Irfan Abas
- Department of Oral Implantology and Restorative Dentistry, Academy and Private Practice, Herenstraat 37, 1404 HC Bussum, The Netherlands;
| | - Marwa Y. Shaheen
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia; (M.Y.S.); (H.S.A.)
| | - Hamdan S. Alghamdi
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia; (M.Y.S.); (H.S.A.)
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Farid M, Ata F, Elhennawy ES, Youssef J. Can Erythropoietin Open a Novel Avenue for Periodontal Regeneration? Cureus 2024; 16:e52825. [PMID: 38406126 PMCID: PMC10884719 DOI: 10.7759/cureus.52825] [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] [Accepted: 01/23/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION Periodontitis is a dramatic inflammatory disease, representing vigorous interactions between specific causative pathogens and host immune responses resulting in the activation of the destructive inflammatory cascade with the subsequent irreversible destruction of the teeth-supporting apparatus. AIM This study aims to evaluate the effect of using erythropoietin (EPO) injectable hydrogel, as an additional therapeutic option to scaling and root planing (SRP) in the treatment of stage II periodontitis patients, and to assess its effect on the level of osteocalcin and interleukin (IL)-1β in the gingival crevicular fluid (GCF). METHODOLOGY A total number of 40 patients clinically diagnosed with stage II periodontitis were included. The participants were allocated into two equal groups: study and control groups. Patients in the control group received SRP, while those in the study group received SRP followed by injectable hydrogel containing EPO. Clinical parameters such as plaque index (PI), gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL) were assessed at baseline and two months post treatment. GCF samples were collected at baseline and two months post treatment from both groups to analyze GCF IL-1β and osteocalcin levels using enzyme-linked immunosorbent assay (ELISA). RESULTS Significant reductions in all tested clinical parameters were revealed in both groups in comparison to baseline values. A marked significant reduction in GCF IL-1β level was detected in the study group. However, two months post treatment, the osteocalcin level was decreased significantly in both groups. CONCLUSION This preliminary study shows great promise for the local application of EPO hydrogel as an adjunct to SRP for the management of stage II periodontitis.
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Affiliation(s)
- Meran Farid
- Department of Periodontology and Oral Medicine, Faculty of Dentistry, Horus University, Demiatta, EGY
| | - Fatma Ata
- Department of Oral Medicine, Periodontology, Diagnosis, and Oral Radiology, Faculty of Dentistry, Mansoura University, Mansoura, EGY
| | - Eman S Elhennawy
- Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura, EGY
| | - Jilan Youssef
- Department of Oral Medicine, Periodontology, Diagnosis, and Oral Radiology, Faculty of Dentistry, Mansoura University, Mansoura, EGY
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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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Pascoal SCD, Estellita MCA, Lima KER, Queiroz EDC, Mendes TAD. Controlled release devices as adjuvants in nonsurgical periodontal therapy: A systematic review. J Indian Soc Periodontol 2023; 27:251-261. [PMID: 37346851 PMCID: PMC10281306 DOI: 10.4103/jisp.jisp_50_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: 01/31/2022] [Revised: 07/18/2022] [Accepted: 08/28/2022] [Indexed: 06/23/2023] Open
Abstract
Controlled release devices (CRD) have been widely studied regarding their application in periodontal therapy. Therefore, the present study aims to evaluate the use and effectiveness of controlled-release devices in nonsurgical periodontal therapy through a systematic review. The research was carried out in six different databases, namely: Online Medical Literature Search and Analysis System (Medline-PubMed), Web of Science, Science Direct, Scopus, Scielo, and Google Scholar. The descriptors "Delayed-Action Preparation," "Therapeutics," and "Periodontitis," were used with their EntryTerms and connected through the Boolean operators AND and OR. A total of 2847 studies were found, and after applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist flowchart, 34 were selected using the eligibility criteria. After that, the qualitative results were tabulated and the risk of bias in each of them was evaluated. It can be observed that the use of CRD presents itself as a successful alternative for adjuvant treatment to periodontal therapy, a fact due to its availability and local concentration in the crevicular fluid. However, further clinical research is still needed to develop devices that are effective, with an easy and quick application, as well as available at a good cost-benefit ratio.
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Sharma P, Singh A, Mallapragada S. Sub-gingival delivery of simvastatin and rosuvastatin for treatment of chronic periodontitis with diabetes mellitus: A randomized controlled clinical-radiographic pilot study. J Oral Biol Craniofac Res 2023; 13:315-320. [PMID: 36891284 PMCID: PMC9988393 DOI: 10.1016/j.jobcr.2023.02.012] [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: 06/26/2022] [Revised: 11/05/2022] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Background Statins are lipid-lowering medications that work by blocking rate-limiting enzyme in cholesterol formation. In patients with Chronic periodontitis (CP) and Diabetes mellitus (DM), subgingival delivery of simvastatin (SMV) and rosuvastatin (RSV) have demonstrated to have bone-stimulatory and anti-inflammatory properties. The current study intended to assess and compare the efficacy of sub-gingivally delivered SMV gel and RSV gel as an adjunctive medication to scaling and root planing (SRP) in the management of intrabony defects in CP patients with type 2 DM. Methods 30 patients with CP and type 2 DM were classified into three treatment groups - SRP + placebo, SRP +1.2% SMV and SRP +1.2% RSV. Clinical parameters: site-specific plaque index, modified sulcus bleeding index (mSBI), pocket probing depth (PPD), and relative attachment level (RAL) were documented at baseline, 3 and 6 months and radiographic parameter: intrabony defect depth (IBD) at baseline and 6 months post-treatment. Results - LDD of 1.2% SMV and 1.2% RSV demonstrated greater clinical and radiographic improvement than placebo, the improvement being statistically significant for PI, mSBI, and PPD for 1.2% SMV and statistically significant for all clinical and radiological parameters for the 1.2% RSV. 1.2% RSV demonstrated greater IBD fill and RAL gain than 1.2% SMV. Conclusion - Localized sub-gingival delivery of statins was beneficial in the treatment intrabony defects in patients with CP and well-controlled type 2 DM. IBD fill and RAL gain were higher with 1.2% RSV than with 1.2% SMV.
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Affiliation(s)
- Pallavi Sharma
- Department of Periodontology, School of Dental Sciences, Sharda University, Plot No. 32, 34, Knowledge Park III, Greater Noida, Uttar Pradesh, 201310, India
| | - Ayushi Singh
- Nimms Multispeciality Hospital, Bisrakh Road, Greater Noida, Uttar Pradesh, 201306, India
| | - Siddharth Mallapragada
- Department of Periodontology, School of Dental Sciences, Sharda University, Plot No. 32, 34, Knowledge Park III, Greater Noida, Uttar Pradesh, 201310, India
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Ali AR, Gautam K, Kapoor A, Mathur S, Choudhary A, Shekhawat A. Comparative evaluation of autogenous bone graft and autologous platelet-rich fibrin with and without 1.2 mg in situ rosuvastatin gel in the surgical treatment of intrabony defect in chronic periodontitis patients. Contemp Clin Dent 2022; 13:69-77. [PMID: 35466293 PMCID: PMC9030313 DOI: 10.4103/ccd.ccd_740_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/26/2020] [Accepted: 10/19/2020] [Indexed: 11/04/2022] Open
Abstract
Context: Rosuvastatin (RSV) is a new synthetic, hydrophilic statin with potent anti-inflammatory and osseodifferentiation actions. Autogenous bone graft (ABG) is still considered the gold standard in reconstructive bone surgery. Addition of platelet-rich fibrin (PRF) to ABG provides sustained release of various growth factors and facilitates survival of the graft. Aims: The study aims to clinically and radiographically compare the effectiveness of ABG and PRF with and without 1.2 mg RSV gel in the surgical treatment of intrabony defect in chronic Periodontitis patient. Settings and Design: This was a randomized controlled clinical trial. Subjects and Methods: Thirty-nine patients (one site per participant) with chronic periodontitis were randomly divided into three groups: Group 1 (open flap debridement [OFD] + placebo), Group 2 (OFD + ABG + PRF), and Group 3 (OFD + ABG + PRF + 1.2 mg RSV). Relative attachment level (RAL) and probing pocket depth (PPD) were recorded at baseline, 3, 6, and 9 months. Radiographic measurements such as defect height (A and B) and defect width (C) were calculated at baseline and 9 months. Statistical Analysis Used: Intergroup comparison was done using Kruskal–Wallis ANOVA. An intragroup comparison was done using Friedman test and Wilcoxon signed-rank test. Results: The mean PPD reduction and mean RAL gain were highly significant in Group 3 and Group 2 than Group 1. For Group 3, a significant reduction of defect height and width and a significant amount of bone fill were achieved than Group 2 and Group 1. Conclusions: Addition of 1.2 mg RSV gel, PRF, and ABG has synergistic effects, explaining their role as a regenerative material in the treatment of intrabony defects.
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Soni A, Raj S, Kashyap L, Upadhyay A, Agrahari V, Sharma A. Comparative effect of 1.2% atorvastatin gel and 1.2% rosuvastatin as a local drug delivery in treatment of intra-bony defects in chronic periodontitis. Indian J Dent Res 2022; 33:180-183. [DOI: 10.4103/ijdr.ijdr_25_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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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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Al-Abedalla K, Gunsolley JC, Shaqman M, Ioannidou E. Unusual Findings in Trials Evaluating Adjuncts to Scaling and Root Planing: Reporting Quality (Part 2). JDR Clin Trans Res 2021; 7:242-255. [PMID: 34609215 DOI: 10.1177/23800844211034831] [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: 11/17/2022] Open
Abstract
INTRODUCTION On the topic of adjuncts to scaling and root planing (SRP), numerous randomized clinical trials (RCTs) were published by a single group of authors and frequently reported unusually large effect sizes. A meta-analysis in part 1 of this project failed to explain the causes for these unusual findings. We assessed the reporting quality and trial registration discrepancies to examine the possibility of replicating the work of this research group as well as the overall rigor of the research methodology. METHODS This study was preregistered at the Open Science Framework (https://osf.io/4meyd/). The Scopus platform was utilized for the RCT search on SRP adjuncts in intrabony defects in patients with periodontitis as compared with SRP alone. The search analysis was limited from 2010 to 2017, and RCTs on SRP adjuncts published by a single research group were selected for screening and inclusion. RCT registration records were assessed for consistency. RESULTS Out of 92 studies that were retrieved from Scopus and PubMed, 32 were included for quality assessment per the CONSORT guidelines (Consolidated Standards of Reporting Trials). Results showed that all RCTs were characterized by a low reporting quality. The majority of CONSORT items scored <50%, including critical items (randomization, registration, and blinding). When registration records were compared with published RCTs, several discrepancies were found. The per-protocol follow-up duration was compared against the study's initiation and termination dates. Only 38% of the RCTs presented a follow-up period within the initiation and termination dates. The remaining RCTs showed inconsistent follow-up in comparison with the initiation and termination dates. CONCLUSION RCTs by this group were characterized by poor adherence to reporting quality guidelines. Crucial RCT elements, such as randomization, blinding, and primary outcomes, were not reported properly. RCT registration records revealed systematic inconsistencies when compared with RCT publication. Therefore, the unusually large effects reported by this group should be viewed with extreme caution. KNOWLEDGE TRANSFER STATEMENT The included randomized clinical trials were characterized by poor adherence to reporting quality guidelines, missing information about important trial items, and discrepancies between the reports and trial registrations. This quality assessment should guide clinical research and show clinicians that they should be cautious when applying evidence in their clinical practice.
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Affiliation(s)
- K Al-Abedalla
- Division of Periodontology, School of Dental Medicine, UCONN Health, Farmington, CT, USA
| | - J C Gunsolley
- Department of Periodontics, Virginia Commonwealth University School of Dentistry, Richmond, VA, 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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Dubar M, Lizambard M, Delcourt-Debruyne E, Batool F, Huck O, Siepmann F, Agossa K. In-situforming drug-delivery systems for periodontal treatment: current knowledge and perspectives. Biomed Mater 2021; 16. [PMID: 34500442 DOI: 10.1088/1748-605x/ac254c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/09/2021] [Indexed: 02/07/2023]
Abstract
Several chemical compounds are considered to be promising as adjuvants in the treatment of periodontitis. Antimicrobials, anti-inflammatory drugs or, more recently, pro-regenerative or antioxidant molecules have shown a very interesting potential to improve the outcomes of mechanical biofilm removal and promote the healing of the damaged tissues. However, their clinical effect is often limited by the challenge of achieving effective and prolonged drug delivery within the periodontal lesion, while limiting the risk of toxicity.In-situforming implants (ISFI) are 'implantable' drug-delivery systems that have gained considerable attention over the last few decades due to their multiple biomedical applications. They are liquids that, when injected at the site to be treated, form a semi-solid or solid dosage form that provides safe and locally controlled drug release. This review discusses current data and future prospects for the use of ISFI in periodontal treatment.
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Affiliation(s)
- Marie Dubar
- University Lille, Inserm, CHU Lille, U1008-Advanced Drug Delivery Systems, F-59000 Lille, France
| | - Martin Lizambard
- University Lille, Inserm, CHU Lille, U1008-Advanced Drug Delivery Systems, F-59000 Lille, France
| | | | - Fareeha Batool
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France.,Université de Strasbourg, Faculté de Chirurgie-dentaire, 8 rue Sainte-Elisabeth, 67000 Strasbourg, France
| | - Olivier Huck
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France.,Université de Strasbourg, Faculté de Chirurgie-dentaire, 8 rue Sainte-Elisabeth, 67000 Strasbourg, France
| | - Florence Siepmann
- University Lille, Inserm, CHU Lille, U1008-Advanced Drug Delivery Systems, F-59000 Lille, France
| | - Kevimy Agossa
- University Lille, Inserm, CHU Lille, U1008-Advanced Drug Delivery Systems, F-59000 Lille, France
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13
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Aslroosta H, Yaghobee S, Akbari S, Kanounisabet N. The effects of topical erythropoietin on non-surgical treatment of periodontitis: a preliminary study. BMC Oral Health 2021; 21:240. [PMID: 33957902 PMCID: PMC8101234 DOI: 10.1186/s12903-021-01607-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/23/2021] [Indexed: 11/19/2022] Open
Abstract
Background The purpose of periodontal treatments is to reduce inflammation, restore gingival health and clinical attachment level gain by controlling microbial plaque formation and other etiological factors. One of the drugs that has been tested in many areas and shown good anti-inflammatory properties is erythropoietin (EPO). We evaluated the effect of this drug on the improvement of periodontitis after the phase I treatment. Methods This study was conducted on 30 patients with stage III periodontitis who had at least two bilateral teeth with CAL of ≥ 5 mm and PPD ≥ 6 mm at ≥ 2 non‐adjacent teeth and bleeding on probing. After oral hygiene instruction and scaling and root planning (SRP), EPO gel containing a solution of 4000 units was applied deeply in the test group and placebo gel was deeply administered in the control pockets (5 times, every other day). The clinical parameters of the plaque index (PI), gingival index (GI), clinical attachment level (CAL), probing depth (PD) and bleeding index (BI) were measured at baseline and after three months of follow up. The P-value was set at 0.05. Results All clinical variables improved after treatment in both groups. The BI and GI scores (which reflects the degree of gingival inflammation) showed statistically more reduction in test group. The CAL decreased from 5.1 ± 4.1 to 3.40 ± 2.71 mm; and 5.67 ± 4.32 to 4.33 ± 3.19 mm in test and control group, respectively (P < 0.00). After the treatment, there was a significant greater reduction in CAL and also PD values in test group (P < 0.01). Conclusion Local application of EPO gel in adjunct to SRP can improve clinical inflammation and CAL gain in periodontitis. Trial registration: This study was registered at 2017-11-06 in IRCT. All procedures performed in this study were approved with ID number of IR.TUMS.DENTISTRY.REC.1396.3139 in Tehran University of medical science. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-021-01607-y.
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Affiliation(s)
- Hoori Aslroosta
- Department of Periodontics, School of Dentistry, Faculty of Dentistry, Tehran University of Medical Sciences, North Kargar Street, Tehran, Iran
| | - Siamak Yaghobee
- Department of Periodontics, School of Dentistry, Faculty of Dentistry, Tehran University of Medical Sciences, North Kargar Street, Tehran, Iran
| | - Solmaz Akbari
- Department of Periodontics, School of Dentistry, Faculty of Dentistry, Tehran University of Medical Sciences, North Kargar Street, Tehran, Iran
| | - Negar Kanounisabet
- Department of Periodontics, School of Dentistry, Faculty of Dentistry, Tehran University of Medical Sciences, North Kargar Street, Tehran, Iran.
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14
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Cruz R, Moraschini V, Calasans-Maia MD, de Almeida DCF, Sartoretto SC, Granjeiro JM. Clinical efficacy of simvastatin gel combined with polypropylene membrane on the healing of extraction sockets: A triple-blind, randomized clinical trial. Clin Oral Implants Res 2021; 32:711-720. [PMID: 33715258 DOI: 10.1111/clr.13740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 03/06/2021] [Accepted: 03/10/2021] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study aimed to evaluate dimensional changes, level of soft tissue healing, and pain/discomfort perception in post-extraction sockets filling with 1.2% simvastatin (SIM) gel covered with polypropylene membranes (PPPM). MATERIAL AND METHODS Twenty-six post-extraction sockets of posterior teeth were randomly allocated in two groups: (a) socket filling with 1.2% SIM gel and covered with PPPM (n = 13) and (b) socket filling with placebo gel and covered with PPPM (n = 13). Cone-beam computed tomography (CBCT) images before and 90 days after the extraction enabled alveolar bone dimensional changes calculation using horizontal and vertical measurements. The measurements occurred at three different levels for thickness located 1, 3, and 5 mm from the top of the bone crest. The vertical (depth) measure was assessed from the most apical portion of the socket to the bone crest's most coronal portion. Seven days after the extractions, the level of soft tissue healing and pain perception were also analyzed. RESULTS After 90 days of extractions, the dimensional changes in thickness in the test group were significantly smaller in sections A (p = .044), B (p = .036) and C (p = .048) when compared to the control group. The test group showed a significantly lower height-dimensional change than the control group (p < .0001). Soft tissue healing index (p = .63), perception of pain (p = .23), and number of analgesics consumed (p = .25) were similar between groups. CONCLUSIONS Simvastatin at 1.2% compared with placebo effectively reduced the dimensional changes in post-extraction sockets covered with PPPM. There was no significant difference in the level of soft tissue healing and postoperative pain between the test and control groups.
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Affiliation(s)
- Rebecca Cruz
- Doctoral Program, Fluminense Federal University, Niteroi Rio de Janeiro, Brazil
| | - Vittorio Moraschini
- Department of Periodontology, Dental Research Division, School of Dentistry, Veiga de Almeida University, Rio de Janeiro, Brazil
| | | | | | - Suelen Cristina Sartoretto
- Department of Periodontology, Dental Research Division, School of Dentistry, Veiga de Almeida University, Rio de Janeiro, Brazil
| | - José Mauro Granjeiro
- Department of Dental Technics, School of Dentistry, Fluminense Federal University, Niterói, Brazil.,National Institute of Metrology, Quality, and Technology (INMETRO), Rio de Janeiro, Brazil
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15
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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: 73] [Impact Index Per Article: 24.3] [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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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: 23] [Impact Index Per Article: 5.8] [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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Elsayed I, El-Dahmy RM, El-Emam SZ, Elshafeey AH, El Gawad NAA, El-Gazayerly ON. Response surface optimization of biocompatible elastic nanovesicles loaded with rosuvastatin calcium: enhanced bioavailability and anticancer efficacy. Drug Deliv Transl Res 2020; 10:1459-1475. [PMID: 32394333 DOI: 10.1007/s13346-020-00761-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Statins are mainly used for the treatment of hyperlipidemia, but recently, their anticancer role was extremely investigated. The goal of this study was to statistically optimize novel elastic nanovesicles containing rosuvastatin calcium to improve its transdermal permeability, bioavailability, and anticancer effect. The elastic nanovesicles were composed of Tween® 80, cetyl alcohol, and clove oil. The nanodispersions were investigated for their entrapment efficiency, particle size, zeta potential, polydispersity index, and elasticity. The optimized elastic nanovesicular dispersion is composed of 20% cetyl alcohol, 53.47% Tween 80, and 26.53% clove oil. Carboxy methylcellulose was utilized to convert the optimized elastic nanovesicular dispersion into elastic nanovesicular gels. Both the optimized dispersion and the optimized gel (containing 2% w/v carboxymethylcellulose) were subjected to in vitro release study, scanning and transmission electron microscopy, histopathological evaluation, and ex vivo permeation. The cell viability assay of the optimized gel on MCF-7 and Hela cell lines showed significant antiproliferative and potent cytotoxic effects when compared to the drug gel. Moreover, the optimized gel accomplished a significant increase in rosuvastatin bioavailability upon comparison with the drug gel. The optimized gel could be considered as a promising nanocarrier for statins transdermal delivery to increase their systemic bioavailability and anticancer effect. Graphical abstract.
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18
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Liang J, Peng X, Zhou X, Zou J, Cheng L. Emerging Applications of Drug Delivery Systems in Oral Infectious Diseases Prevention and Treatment. Molecules 2020; 25:E516. [PMID: 31991678 PMCID: PMC7038021 DOI: 10.3390/molecules25030516] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 12/27/2022] Open
Abstract
The oral cavity is a unique complex ecosystem colonized with huge numbers of microorganism species. Oral cavities are closely associated with oral health and sequentially with systemic health. Many factors might cause the shift of composition of oral microbiota, thus leading to the dysbiosis of oral micro-environment and oral infectious diseases. Local therapies and dental hygiene procedures are the main kinds of treatment. Currently, oral drug delivery systems (DDS) have drawn great attention, and are considered as important adjuvant therapy for oral infectious diseases. DDS are devices that could transport and release the therapeutic drugs or bioactive agents to a certain site and a certain rate in vivo. They could significantly increase the therapeutic effect and reduce the side effect compared with traditional medicine. In the review, emerging recent applications of DDS in the treatment for oral infectious diseases have been summarized, including dental caries, periodontitis, peri-implantitis and oral candidiasis. Furthermore, oral stimuli-responsive DDS, also known as "smart" DDS, have been reported recently, which could react to oral environment and provide more accurate drug delivery or release. In this article, oral smart DDS have also been reviewed. The limits have been discussed, and the research potential demonstrates good prospects.
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Affiliation(s)
| | | | | | - Jing Zou
- State Key Laboratory of Oral Diseases& West China School of Stomatology& National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu 610041, China; (J.L.); (X.P.); (X.Z.)
| | - Lei Cheng
- State Key Laboratory of Oral Diseases& West China School of Stomatology& National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu 610041, China; (J.L.); (X.P.); (X.Z.)
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19
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Li X, Liu X, Ni S, Liu Y, Sun H, Lin Q. Enhanced osteogenic healing process of rat tooth sockets using a novel simvastatin-loaded injectable microsphere-hydrogel system. J Craniomaxillofac Surg 2019; 47:1147-1154. [DOI: 10.1016/j.jcms.2019.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/01/2019] [Accepted: 04/18/2019] [Indexed: 12/21/2022] Open
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20
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Cao R, Li Q, Chen Y, Yao M, Wu Q, Zhou H. Efficacy of locally-delivered statins adjunct to non-surgical periodontal therapy for chronic periodontitis: a Bayesian network analysis. BMC Oral Health 2019; 19:105. [PMID: 31196047 PMCID: PMC6567452 DOI: 10.1186/s12903-019-0789-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 05/20/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Studies indicate locally-delivered statins offer additional benefits to scaling and root planning (SRP), however, it is still hard to say which type of statins is better. This network meta-analysis aimed to assess the effect of locally-delivered statins and rank the most efficacious statin for treating chronic periodontitis (CP) in combination with SRP. METHODS We screened four literature databases (Pubmed, Embase, Cochrane Library, and Web of Science) for randomized controlled clinical trials (RCTs) published up to June 2018 that compared different statins in the treatment of chronic periodontitis. The outcomes analyzed were changes in intrabony defect depth (IBD), pocket depth (PD), and clinical attachment level (CAL). We carried out Bayesian network meta-analysis of CP without systemic diseases. Traditional and Bayesian network meta-analyses were conducted using random-effects models. RESULTS Greater filling of IBD, reduction in PD, and gain in CAL were observed for SRP treated in combination with statins when compared to SRP alone for treating CP without systemic diseases. Specifically, SRP+ Atorvastatin (ATV) (mean difference [MD]: 1.5 mm, 1.4 mm, 1.8 mm, respectively), SRP + Rosuvastatin (RSV) (MD: 1.8 mm, 2.0 mm, 2.1 mm, respectively), and SRP + Simvastatin (SMV) (MD: 1.1 mm, 2.2 mm, 2.1 mm, respectively) were identified. However, no difference was found among the statins tested. In CP patients with type 2 diabetic (T2DM) or in smokers, additional benefits were observed from locally delivered statins. CONCLUSION Local statin use adjunctive to SRP confers additional benefits in treating CP by SRP, even in T2DM and smokers. RSV may be the best one to fill in IBD. However, considering the limitations of this study, clinicians must use cautious when applying the results and further studies are required to explore the efficacy of statins in CP with or without the risk factors (T2DM comorbidity or smoking history).
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Affiliation(s)
- Ruoyan Cao
- Department of Prosthodontics, Xiangya Stomatological Hospital & School of Stomatology, Central South University, 72 Xiangya Road, Changsha, 410000 China
| | - Qiulan Li
- Department of Stomatology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410011 China
| | - Yu Chen
- Department of Prosthodontics, Xiangya Stomatological Hospital & School of Stomatology, Central South University, 72 Xiangya Road, Changsha, 410000 China
| | - Mianfeng Yao
- Department of Oral Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410083 China
| | - Qiqi Wu
- Department of Operative Dentistry and Endodontics, Stomatological Hospital & School of Stomatology, Central South University, 72 Xiangya Road, Changsha, 410000 China
| | - Hongbo Zhou
- Department of Prosthodontics, Xiangya Stomatological Hospital & School of Stomatology, Central South University, 72 Xiangya Road, Changsha, 410000 China
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21
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Efficacy of Locally Administered 1.2% Rosuvastatin Gel in Patients with Periodontitis: A Randomized Placebo Controlled Clinical Trial. Eur J Dent 2019; 13:29-35. [PMID: 31170754 PMCID: PMC6635963 DOI: 10.1055/s-0039-1688522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective
Periodontitis initiation and progression are a result of host immune inflammatory response to oral pathogens. Several pharmacological agents are being delivered locally, to improve periodontal health. Hence, the present randomized placebo controlled clinical trial is designed to check the clinical and antimicrobial efficacy of locally delivered 1.2% rosuvastatin (RSV) in intrabony defects (IBD) in periodontitis patients.
Materials and Methods
One-hundred patients were randomly allotted into two treatment groups: group A received 1. 2% RSV gel, scaling and root debridement and group B received placebo gel, scaling and root debridement. Clinical parameters, including modified sulcus bleeding index (mSBI), probing depth (PD), clinical attachment level (CAL), and plaque index (PI), were recorded at baseline before phase 1 and after 6 months. Radiographic assessment of IBD was done by cone beam computed tomography at baseline and after 6 months. Anaerobic colony count was done at baseline and after 180 days.
Results
On intragroup comparison, there is a significant improvement in periodontal parameters in both the groups. On intergroup comparison, there is significant gain in CAL in group A than group B (
p
= 0.04). There is significant decrease in PD in group A, compared to group B. There is significant bone fill in group A (
p
= 0.034), compared to group B. With respect to mSBI, PI, and anaerobic colony count, there is no significant difference between the two groups after 6 months. No adverse effect was noticed in any subjects.
Conclusion
The author concludes that 1.2% RSV gel when delivered locally into IBD improved periodontal clinical parameters such as PD and CAL and showed significant bone fill.
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22
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Carvalho Dutra B, Oliveira AMSD, Oliveira PAD, Miranda Cota LO, Silveira JO, Costa FO. Effects of topical application of 1% sodium alendronate gel in the surgical treatment of periodontal intrabony defects: A 6-month randomized controlled clinical trial. J Periodontol 2019; 90:1079-1087. [PMID: 31071760 DOI: 10.1002/jper.19-0160] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/29/2019] [Accepted: 05/01/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Sodium alendronate (ALN) is an aminobisphosphonate and potent inhibitor of bone resorption. It has been suggested that ALN might be a promising carrier of biomolecules for periodontal bone repair. The aim of this randomized split-mouth clinical trial was to evaluate the effects of the topical application of 1% ALN gel in intrabony defects during the surgical treatment of patients with periodontitis. METHODS Sixty-four intrabony defects from 32 patients with periodontitis were randomly treated with either 1% ALN gel or placebo gel during periodontal surgeries. Full-mouth periodontal examination was performed at baseline and at 3 and 6 months after surgical treatment. Clinical attachment level (CAL), probing depth (PD), and bleeding on probing (BOP) were recorded as the clinical outcomes. Bone defects were evaluated by digital subtraction radiography (DSR) at baseline and 6 months post-treatment. Analyses were performed through Fisher, Kruskal-Wallis, and ANOVA tests and a generalized estimation equations method. RESULTS Both ALN and placebo groups showed significant improvements in BOP, PD, and CAL after periodontal surgical procedures (P < 0.001). Intergroup analysis showed significantly better outcomes in the ALN group with higher PD reduction and clinical attachment gain. DSR showed positive effects on periodontal bone repair strongly associated in the ALN group (P < 0.001). CONCLUSION Topical application of 1% ALN may be a promising and beneficial adjuvant for the treatment of intrabony defects during surgical periodontal therapy.
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Affiliation(s)
- Bernardo Carvalho Dutra
- Department of Dental Clinics, Oral Surgery and Oral Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - Luís Otávio Miranda Cota
- Department of Dental Clinics, Oral Surgery and Oral Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Juliana Oliveira Silveira
- Department of Dental Clinics, Oral Surgery and Oral Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fernando Oliveira Costa
- Department of Dental Clinics, Oral Surgery and Oral Pathology, School of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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23
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Contribution of Statins towards Periodontal Treatment: A Review. Mediators Inflamm 2019; 2019:6367402. [PMID: 30936777 PMCID: PMC6415285 DOI: 10.1155/2019/6367402] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 12/23/2018] [Indexed: 01/09/2023] Open
Abstract
The pleiotropic effects of statins have been evaluated to assess their potential benefit in the treatment of various inflammatory and immune-mediated diseases including periodontitis. Herein, the adjunctive use of statins in periodontal therapy in vitro, in vivo, and in clinical trials was reviewed. Statins act through several pathways to modulate inflammation, immune response, bone metabolism, and bacterial clearance. They control periodontal inflammation through inhibition of proinflammatory cytokines and promotion of anti-inflammatory and/or proresolution molecule release, mainly, through the ERK, MAPK, PI3-Akt, and NF-κB pathways. Moreover, they are able to modulate the host response activated by bacterial challenge, to prevent inflammation-mediated bone resorption and to promote bone formation. Furthermore, they reduce bacterial growth, disrupt bacterial membrane stability, and increase bacterial clearance, thus averting the exacerbation of infection. Local statin delivery as adjunct to both nonsurgical and surgical periodontal therapies results in better periodontal treatment outcomes compared to systemic delivery. Moreover, combination of statin therapy with other regenerative agents improves periodontal healing response. Therefore, statins could be proposed as a potential adjuvant to periodontal therapy. However, optimization of the combination of their dose, type, and carrier could be instrumental in achieving the best treatment response.
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24
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Pankaj D, Sahu I, Kurian IG, Pradeep AR. Comparative evaluation of subgingivally delivered 1.2% rosuvastatin and 1% metformin gel in treatment of intrabony defects in chronic periodontitis: A randomized controlled clinical trial. J Periodontol 2018; 89:1318-1325. [PMID: 29802627 DOI: 10.1002/jper.17-0434] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 03/08/2018] [Accepted: 03/20/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of this study is to explore and compare the clinical efficacy of locally delivered 1.2% Rosuvastatin (RSV) and 1% Metformin (MF) gel as an adjunct to scaling and root planning (SRP) in the treatment of intrabony defects in chronic periodontitis patients. METHODS A total of 90 volunteers were randomly assigned to three treatment groups; 1) SRP plus placebo gel; 2) SRP plus 1.2% RSV gel; 3) SRP plus 1% MF gel. Clinical parameters like modified sulcus bleeding index (mSBI), plaque index (PI), pocket probing depth (PD) and clinical attachment level (CAL) were recorded at baseline, 6 and 12 months and the radiologic assessment of bone defect fill was performed at 6 and 12 months. RESULTS mSBI, BP, PD, and CAL were improved in all the groups, however mean reductions in PD, CAL gain, and percentage of bone fill was found to be higher in RSV and MF groups than placebo group at all visits. CONCLUSION Adjunctive use of locally delivered 1.2% RSV and 1% MF gel stimulates a significant PD reduction, CAL gains and improved bone fill when compared with placebo gel. Results were significantly better with the use of 1.2% RSV gel than 1% MF gel.
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Affiliation(s)
- Dileep Pankaj
- Department of Periodontology, Government Dental College & Research Institute, Bengaluru, India
| | - Ipshita Sahu
- Department of Periodontology, Government Dental College & Research Institute, Bengaluru, India
| | - Ida Grace Kurian
- Department of Periodontology, Government Dental College & Research Institute, Bengaluru, India
| | - A R Pradeep
- Department of Periodontology, Government Dental College & Research Institute, Bengaluru, India
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Bertl K, Parllaku A, Pandis N, Buhlin K, Klinge B, Stavropoulos A. The effect of local and systemic statin use as an adjunct to non-surgical and surgical periodontal therapy-A systematic review and meta-analysis. J Dent 2018; 67:18-28. [PMID: 28855141 DOI: 10.1016/j.jdent.2017.08.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/19/2017] [Accepted: 08/23/2017] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To evaluate the effect of local and/or systemic statin use as an adjunct to non-surgical and/or surgical periodontal therapy. DATA Literature search according to PRISMA guidelines with the following eligibility criteria: (a) English or German language; (b) interventional studies; (c) statins as monotherapy or as an adjunct to non-surgical and/or surgical treatment of periodontitis; (d) clinical and/or radiographic treatment effect size of statin intake reported. SOURCES Medline (PubMed), Embase (Ovid), CENTRAL (Ovid). STUDY SELECTION Thirteen clinical studies regarding local application and 2 with systemic administration of statins as an adjunct to non-surgical treatment (SRP) and 4 studies regarding intrasurgical statin application with a maximum follow-up of 9 months could be included; simvastatin, atorvastatin, and rosuvastatin were used. Local but not systemic statin application as an adjunct to SRP yielded significantly larger probing pocket depth (PD), radiographic defect depth (RDD), and bleeding index reduction, and larger clinical attachment level gain, and less residual PD and RDD (p≤0.016); rosuvastatin appeared as the most efficacious. Three of 4 studies reported a significant positive effect of intrasurgical statin application. No adverse events were reported after statin use. The vast majority of the included studies were from the same research group. CONCLUSIONS Significant additional clinical and radiographic improvements are obtained after local, but not systemic, statin use as an adjunct to SRP in deep pockets associated with intrabony defects and seemingly with furcation defects; intrasurgical statin application seems similarly beneficial. Confirmation of these results, and especially of the effect size, from other research groups is warranted.
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Affiliation(s)
- Kristina Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Sweden; Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Austria
| | - Arlinda Parllaku
- Private Practice, Tirana, Albania; Postgraduate Course Periodontology, Medical University of Vienna
| | - Nikolaos Pandis
- School of Dental Medicine, Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Switzerland
| | - Kåre Buhlin
- Department of Dental Medicine, Division of Periodontology, Karolinska Institute, Huddinge, Sweden
| | - Björn Klinge
- Department of Periodontology, Faculty of Odontology, University of Malmö, Sweden
| | - Andreas Stavropoulos
- Department of Periodontology, Faculty of Odontology, University of Malmö, Sweden.
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Meza-Mauricio J, Soto-Peñaloza D, Peñarrocha-Oltra D, Montiel-Company JM, Peruzzo DC. Locally applied statins as adjuvants to non-surgical periodontal treatment for chronic periodontitis: a systematic review and meta-analysis. Clin Oral Investig 2018; 22:2413-2430. [DOI: 10.1007/s00784-018-2507-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 05/30/2018] [Indexed: 12/22/2022]
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Muniz FWMG, Taminski K, Cavagni J, Celeste RK, Weidlich P, Rösing CK. The effect of statins on periodontal treatment-a systematic review with meta-analyses and meta-regression. Clin Oral Investig 2018; 22:671-687. [PMID: 29396642 DOI: 10.1007/s00784-018-2354-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 01/23/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study aimed to systematically review clinical trials about the effect of statins as adjunct to mechanical periodontal therapy, on probing pocket depth, clinical attachment level, and intrabony defects, in comparison to mechanical periodontal therapy alone or in association with placebo. MATERIAL AND METHODS Three databases were searched for controlled clinical trials that used any locally delivered or systemically statin as a sole adjunctive therapy to mechanical periodontal treatment. Weighted mean differences between baseline and 6 months after periodontal treatment for clinical attachment level (CAL), probing pocket depth (PPD), and intrabony defect (IBD) were calculated. A high heterogeneity was detected. Therefore, a meta-regression adjusted for type of statin and year of publication was performed. RESULTS Fifteen studies were included in the systematic review, and ten studies were included in the meta-analysis. In the meta-regression, the adjunct use of simvastatin, rosuvastatin, and atorvastatin additionally reduced PPD in comparison to mechanical periodontal therapy and a placebo gel (2.90 ± 0.35, 3.90 ± 0.77, 3.06 ± 0.71 mm, respectively; p < 0.05). Regarding the resolution of IBD, simvastatin and rosuvastatin significantly improved in comparison to control group (0.89 ± 0.35 and 1.93 ± 0.77 mm, respectively; p < 0.05). No statistically significant difference was found between the statins for both PPD and IBD (p < 0.05). Regarding CAL gain, simvastatin provided a statistically significant improvement as compared to the control group (2.02 ± 0.79 mm; p = 0.043). CONCLUSIONS The use of statins, used as sole adjuncts to mechanical periodontal treatment, improved the periodontal parameters. In the quantitative analyses, simvastatin was the only drug that showed additional benefits in all evaluated parameters. CLINICAL RELEVANCE Statins promote significantly clinical periodontal improvements when administered in association with non-surgical scaling and root planning (SRP), when compared to SRP alone or in association with a placebo.
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Affiliation(s)
- Francisco Wilker Mustafa Gomes Muniz
- Department of Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil.
| | - Keity Taminski
- Department of Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil
| | - Juliano Cavagni
- Department of Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil
| | - Roger Keller Celeste
- Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil
| | - Patrícia Weidlich
- Department of Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil
| | - Cassiano Kuchenbecker Rösing
- Department of Periodontology, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. Rua Ramiro Barcelos, 2492, Porto Alegre, RS, 90035-003, Brazil
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Akram Z, Vohra F, Javed F. Efficacy of statin delivery as an adjunct to scaling and root planing in the treatment of chronic periodontitis: A meta-analysis. ACTA ACUST UNITED AC 2017; 9:e12304. [PMID: 29119729 DOI: 10.1111/jicd.12304] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 08/30/2017] [Indexed: 12/21/2022]
Abstract
The action of statins in stimulating bone formation and having other pleiotropic effects, such as anti-inflammatory and immunomodulatory effects, has justified their use as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis (CP). The aim of the present study was to evaluate the efficacy of statin delivery as an adjunct to SRP in the treatment of CP. Electronic searches were conducted using the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register, up until July 2017. The primary outcome was probing depth (PD), while the secondary outcomes were changes in clinical attachment level (CAL) and bone defect (BD) fill. Eleven studies were included, and all showed significant PD reduction, CAL gain, and BD fill with adjunctive statin delivery compared to SRP alone. The meta-analysis showed significant improvement in periodontal parameters for atorvastatin (PD: weighted mean difference [WMD] = -1.84, -2.56 to -1.12, P < .001; CAL: WMD = -2.31, -3.58 to -1.03, P < .001; BD fill: WMD = 2.66, -3.92 to -1.39, P < .001), simvastatin (PD: WMD = -1.91, -2.27 to -1.55, P < .001; CAL: WMD = -1.91, -2.27 to -1.55, P = .001; BD: WMD = -1.52, -2.20 to -0.85, P < .001), and rosuvastatin (PD: WMD = -0.94, -1.32 to -0.55, P < .001; CAL: WMD = -1.00, -1.41 to -0.60, P < .001; BD fill: WMD = -1.30, -1.80 to -0.79, P < .001). Adjunctive statin delivery appears to be effective in reducing PD, CAL gain, and BD fill in CP, and therefore, these drugs could be a promising therapeutic option for periodontal regeneration in future.
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Affiliation(s)
- Zohaib Akram
- Department of Periodontology, Faculty of Dentistry, Ziauddin University, Karachi, Pakistan
| | - Fahim Vohra
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Fawad Javed
- Department of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, New York, USA
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Kırzıoğlu FY, Özmen Ö, Doğan B, Bulut MT, Fentoğlu Ö, Özdem M. Effects of rosuvastatin on inducible nitric oxide synthase in rats with hyperlipidaemia and periodontitis. J Periodontal Res 2017; 53:258-266. [PMID: 29086411 DOI: 10.1111/jre.12513] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVE Nitric oxide is a free radical that is synthesized from l-arginine by nitric oxide synthase (NOS). The level of inducible NOS (iNOS) in gingiva with periodontitis is higher than that in healthy gingiva. The aim of this study was to evaluate the effects of rosuvastatin administration on alveolar bone loss (ABL) and iNOS(+) cell counts in gingival tissues in rats with ligature-induced experimental periodontitis with/without hyperlipidaemia. MATERIAL AND METHODS The rats were randomly divided into seven groups: Hy (cholesterol-added diet/water administration); HyP (cholesterol-added diet/periodontitis/water administration); HyPR (cholesterol-added diet/periodontitis/rosuvastatin administration); P (standard diet/periodontitis/water administration); PR (standard diet/periodontitis/rosuvastatin administration); C (standard diet/water administration); and R (standard diet/rosuvastatin administration). Experimental periodontitis was induced with silk ligatures, and rosuvastatin/water was administered to rats by oral gavage for the last 2 weeks of the 8-week study. After the rats were killed in week 8, histomorphometric and histological analyses were performed. Immunostained iNOS(+) cells were counted in the gingival samples and the Mann-Whitney U-test was used for statistical analysis. RESULTS The experimental groups exhibited increases in total cholesterol and low-density lipoprotein, except for Groups C and R. The cholesterol-added diet induced ABL in Group Hy. Of the periodontitis groups, the lowest ABL was found in Group PR. While there was a significant difference in ABL between Groups P (0.82 ± 0.15 mm) and PR (0.70 ± 0.21 mm) receiving a standard diet (P < .05), no difference was observed between Groups HyP (0.77 ± 0.07 mm) and HyPR (0.76 ± 0.11 mm) receiving a cholesterol-added diet (P ˃ .05). Rosuvastatin significantly reduced expression of iNOS in Groups PR (18.40 ± 2.31%) and HyPR (24.00 ± 4.83%) compared with Group P (30.90 ± 2.42%; P < .001). However, a larger number of iNOS(+) cells was found in Group HyPR than in Group PR (P < .001). CONCLUSION Administration of rosuvastatin reduced gingival iNOS expression in ligature-induced periodontitis with/without hyperlipidaemia. It also led to significant differences in ABL in rats with periodontitis, except when periodontitis was associated with hyperlipidaemia. These findings could provide an important contribution in further studies to evaluate the role of rosuvastatin as a host modulatory agent in the pathogenesis of periodontal diseases.
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Affiliation(s)
- F Y Kırzıoğlu
- Department of Periodontology, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey
| | - Ö Özmen
- Department of Pathology, Faculty of Veterinary Medicine, Mehmet Akif Ersoy University, Burdur, Turkey
| | - B Doğan
- Department of Periodontology, Faculty of Dentistry, Mustafa Kemal University, Hatay, Turkey
| | - M T Bulut
- Private Elitia Oral and Dental Health Polyclinic, Alanya - Antalya, Turkey
| | - Ö Fentoğlu
- Department of Periodontology, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey
| | - M Özdem
- Private Clinic, Bolu, Turkey
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Ambrósio LMB, Rovai ES, Sendyk DI, Holzhausen M, Pannuti CM. Does the adjunctive use of statins provide additional benefits to nonsurgical periodontal treatment? A systematic review and meta-analysis. J Periodontal Res 2017; 53:12-21. [PMID: 28872188 DOI: 10.1111/jre.12480] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2017] [Indexed: 12/13/2022]
Abstract
Adjunctive therapeutic agents may be used to improve the response to nonsurgical periodontal therapy. Local delivery of statins (simvastatin, artovastatin and rosuvastatin) is a promising adjunct to scaling and root planing (SRP). Thus, the aim of this review is to evaluate if adjunctive local delivery of statins is more effective than SRP alone. Randomized clinical trials that presented a test group evaluating local delivery of statins as adjuncts in healthy, diabetic and smoking patients were included. Medline and the Cochrane library database were searched up to November 2016. Random effects meta-analyses were conducted for pocket depth change and clinical attachment gain. One hundred and twenty-five studies potentially related to the aim of this review were screened, but only 10 were included. The majority of the trials reported additional clinical benefits in the groups that were treated with adjunctive local delivery of statins. Pooled calculations showed that local delivery of statins resulted in additional reduction of pocket depth and clinical attachment gain in healthy people, smokers and diabetic patients. Local statins may offer additional clinical benefits to SRP, even in smokers and diabetics.
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Affiliation(s)
- L M B Ambrósio
- Department of Stomatology, Division of Periodontics, Faculty of Dentistry, University of São Paulo, São Paulo, Brazil
| | - E S Rovai
- Department of Stomatology, Division of Periodontics, Faculty of Dentistry, University of São Paulo, São Paulo, Brazil
| | - D I Sendyk
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of São Paulo, São Paulo, Brazil
| | - M Holzhausen
- Department of Stomatology, Division of Periodontics, Faculty of Dentistry, University of São Paulo, São Paulo, Brazil
| | - C M Pannuti
- Department of Stomatology, Division of Periodontics, Faculty of Dentistry, University of São Paulo, São Paulo, Brazil
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Saifi AM, Giraddi GB, Ahmed N. Healing of extraction socket following local application of simvastatin: A split mouth prospective study. J Oral Biol Craniofac Res 2017; 7:106-112. [PMID: 28706784 DOI: 10.1016/j.jobcr.2017.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/02/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The role of simvastatin in lowering serum cholesterol level is well described. However, recent findings suggest they have a role in bone formation as well. AIM AND OBJECTIVES The present prospective study was conducted to evaluate the efficacy of simvastatin on bone formation in extraction sockets. MATERIALS AND METHODS 15 patients undergoing all four first premolar extraction were selected based on inclusion and exclusion criteria. Extraction sockets of left premolars (24 and 34) were considered as cases and right premolars (14 and 44) as controls. Overall 30 extraction sites were assigned to each group. Atraumatic extraction was done in all cases following which simvastatin mixed with gelatin sponge was placed in extraction socket of 24 and 34 while only gelatin sponge was placed in 14 and 44. All sockets were then closed with 3-0 vicryl. The patients were kept on follow-up and complications such as dry socket, pain, and swelling were recorded. Intra oral peri apical radiographs were taken immediately after extraction and at 2nd month and 4th month to record changes in the density of alveolar bone. The radiographic measurements were compared and the differences were statistically analyzed. RESULT Percent increase in bone density at the end of 8th week and 16th week was significantly high in case as compared to the control group. CONCLUSION Local application of simvastatin induces bone formation in extraction sockets. Application is very simple and provides a very cost effective way of faster bone regeneration following tooth extraction.
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Affiliation(s)
- Aamir Malick Saifi
- Department of Oral & Maxillofacial Surgery, Government Dental College & Research Institute, Bangalore, India
| | - Girish B Giraddi
- Department of Oral & Maxillofacial Surgery, Government Dental College & Research Institute, Bangalore, India
| | - Nausheer Ahmed
- Department of Orthodontics, Government Dental College & Research Institute, Bangalore, India
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Messora MR, Apolinário Vieira GH, Vanderlei JMTMM, Mariguela VC, Fernandes PG, Palioto DB, Scombatti de Souza SL, Novaes AB, Furlaneto F, Taba M. Rosuvastatin promotes benefits on induced periodontitis in hypertensive rats. J Periodontal Res 2017; 52:734-744. [DOI: 10.1111/jre.12442] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2016] [Indexed: 01/04/2023]
Affiliation(s)
- M. R. Messora
- Department of Oral Surgery and Periodontology; Ribeirão Preto School of Dentistry; University of São Paulo - USP; Ribeirão Preto São Paulo Brazil
| | - G. H. Apolinário Vieira
- Department of Oral Surgery and Periodontology; Ribeirão Preto School of Dentistry; University of São Paulo - USP; Ribeirão Preto São Paulo Brazil
| | - J. M. T. M. M. Vanderlei
- Department of Oral Surgery and Periodontology; Ribeirão Preto School of Dentistry; University of São Paulo - USP; Ribeirão Preto São Paulo Brazil
| | - V. C. Mariguela
- Department of Oral Surgery and Periodontology; Ribeirão Preto School of Dentistry; University of São Paulo - USP; Ribeirão Preto São Paulo Brazil
| | - P. G. Fernandes
- Department of Oral Surgery and Periodontology; Ribeirão Preto School of Dentistry; University of São Paulo - USP; Ribeirão Preto São Paulo Brazil
| | - D. B. Palioto
- Department of Oral Surgery and Periodontology; Ribeirão Preto School of Dentistry; University of São Paulo - USP; Ribeirão Preto São Paulo Brazil
| | - S. L. Scombatti de Souza
- Department of Oral Surgery and Periodontology; Ribeirão Preto School of Dentistry; University of São Paulo - USP; Ribeirão Preto São Paulo Brazil
| | - A. B. Novaes
- Department of Oral Surgery and Periodontology; Ribeirão Preto School of Dentistry; University of São Paulo - USP; Ribeirão Preto São Paulo Brazil
| | - F. Furlaneto
- Department of Oral Surgery and Periodontology; Ribeirão Preto School of Dentistry; University of São Paulo - USP; Ribeirão Preto São Paulo Brazil
| | - M. Taba
- Department of Oral Surgery and Periodontology; Ribeirão Preto School of Dentistry; University of São Paulo - USP; Ribeirão Preto São Paulo Brazil
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Garg S, Pradeep A. 1.2% Rosuvastatin and 1.2% Atorvastatin Gel Local Drug Delivery and Redelivery in the Treatment of Class II Furcation Defects: A Randomized Controlled Clinical Trial. J Periodontol 2017; 88:259-265. [DOI: 10.1902/jop.2016.160399] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Shruti Garg
- Department of Periodontology, Government Dental College and Research Institute, Bangalore, Karnataka, India
| | - A.R. Pradeep
- Department of Periodontology, Government Dental College and Research Institute, Bangalore, Karnataka, India
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Gualtero DF, Viafara-Garcia SM, Morantes SJ, Buitrago DM, Gonzalez OA, Lafaurie GI. Rosuvastatin Inhibits Interleukin (IL)-8 and IL-6 Production in Human Coronary Artery Endothelial Cells Stimulated With Aggregatibacter actinomycetemcomitans Serotype b. J Periodontol 2017; 88:225-235. [DOI: 10.1902/jop.2016.160288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Kırzıoğlu FY, Tözüm Bulut M, Doğan B, Fentoğlu Ö, Özmen Ö, Çarsancaklı SA, Ergün AG, Özdem M, Orhan H. Anti-inflammatory effect of rosuvastatin decreases alveolar bone loss in experimental periodontitis. J Oral Sci 2017. [DOI: 10.2334/josnusd.16-0398] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Fatma Y. Kırzıoğlu
- Periodontology Department, Faculty of Dentistry, University of Süleyman Demirel
| | - Memduha Tözüm Bulut
- Periodontology Department, Faculty of Dentistry, University of Süleyman Demirel
| | - Burak Doğan
- Periodontology Department, Faculty of Dentistry, University of Mustafa Kemal
| | - Özlem Fentoğlu
- Periodontology Department, Faculty of Dentistry, University of Süleyman Demirel
| | - Özlem Özmen
- Pathology Department, Faculty of Veterinary Medicine, University of Mehmet Akif Ersoy
| | | | - Ayşe G. Ergün
- Microbiology Department, Konya Numune Training and Research Hospital
| | - Muhsin Özdem
- Periodontology Department, Faculty of Dentistry, University of Abant Izzet Baysal
| | - Hikmet Orhan
- Biostatistics and Medical Informatics Department, Faculty of Medicine, University of Süleyman Demirel
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Sinjab K, Zimmo N, Lin GH, Chung MP, Shaikh L, Wang HL. The Effect of Locally Delivered Statins on Treating Periodontal Intrabony Defects: A Systematic Review and Meta-Analysis. J Periodontol 2016; 88:357-367. [PMID: 27767388 DOI: 10.1902/jop.2016.160384] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Use of statins on adult patients with chronic periodontitis shows a positive effect on their periodontal status. However, effect of locally delivered statins on periodontal treatment has not yet been systematically analyzed. Hence, the present systematic review and meta-analysis aims to evaluate efficacy of statins on treating localized periodontal intrabony defects (IBDs). METHODS An electronic search of three databases (PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature) between January 1, 1965 and March 1, 2016, and a hand search of peer-reviewed journals for relevant articles were performed. Controlled randomized clinical trials (RCTs) and prospective studies with data on comparison between adjunctive locally delivered statin use to mechanical scaling and root planing (SRP) and placebo in each group, with minimum 10 participants and follow-up period of at least 6 months, were included. RESULTS Ten studies, eight RCTs and two prospective studies, were included. Each study included 15 to 105 patients between 25 and 55 years of age. Statistical results were recorded; weighted mean difference (WMD) and confidence interval (CI) were calculated; and meta-analyses were performed for defect fill, probing depth (PD) reduction, and clinical attachment level (CAL) gain in both statin and placebo/no treatment groups. Overall analysis of defect fill presented WMD of 1.37 mm (95% CI = 0.96 to 1.77; P <0.0001), PD reduction presented WMD of 1.76 mm (95% CI = 1.04 to 2.47; P <0.0001), and CAL gain presented WMD of 1.58 mm (95% CI = 0.89 to 2.28; P <0.0001). However, comparison presented considerable heterogeneity among studies. CONCLUSIONS This systematic review and meta-analysis find that adjunctive use of locally delivered statins to mechanical SRP is beneficial to increasing bone fill percentage. Improved inflammatory and bleeding control as well as PD reduction and CAL gain are possible advantages to using these drugs in treating patients with periodontal IBDs.
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Affiliation(s)
- Khaled Sinjab
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Nouf Zimmo
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Guo-Hao Lin
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI.,Department of Surgical Sciences, Marquette University School of Dentistry, Milwaukee, WI
| | - Ming-Pang Chung
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Lujain Shaikh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI
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The influence of oral administration of rosuvastatin on calvarial bone healing in rats. J Craniomaxillofac Surg 2016; 44:1327-32. [PMID: 27527680 DOI: 10.1016/j.jcms.2016.04.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 03/10/2016] [Accepted: 04/14/2016] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study is to investigate the potential of the systemic administration of different doses of rosuvastatin (RSV) on autogenous grafted critical-sized cortical bone defects. Twenty-four rats were divided into three groups: Group C (control), Group RSV-2 and Group RSV-5. A 5-mm diameter critical-size defect was created in the calvarium of each animal. In Group C, the defect was filled by autogenous graft only and rats were given saline solution with oral gavage for 28 days. In Group RSV-2 defects were filled with autogenous graft and rats were given 2 mg/kg rosuvastatin with oral gavage for 28 days. In Group RSV-5 defects were filled with autogenous graft and rats were given 5 mg/kg rosuvastatin with oral gavage for 28 days. All animals were euthanized at 28 days postoperative. Stereologic and micro-CT analyses were performed. New bone area (NBA) and connective tissue volumes were measured. Stereologic analysis showed that Group RSV-5 and RSV-2 had significantly more new bone at 4 weeks compared with group C. Connective tissue volumes were also significantly higher in RSV applicated groups. New bone and connective tissue volumes' difference were not statistically significant between RSV groups. Micro-CT results were similar with stereologic analyses. Orally administered RSV enhances bone regeneration in critical size calvarial rat defects filled with autogenous graft furthermore possible inflammatory effect should be investigated.
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Pradeep AR, Garg V, Kanoriya D, Singhal S. Platelet-Rich Fibrin With 1.2% Rosuvastatin for Treatment of Intrabony Defects in Chronic Periodontitis: A Randomized Controlled Clinical Trial. J Periodontol 2016; 87:1468-1473. [PMID: 27452270 DOI: 10.1902/jop.2016.160015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Regenerative periodontal therapy encompasses use of various bioactive agents that are not only inflammomodulatory but also osteoclast-inhibitory or, rather, osteostimulative. Hypolipidemic statin drugs, particularly rosuvastatin (RSV), are known to be associated with alveolar bone formation and periodontal improvements. Platelet analogs such as platelet-rich fibrin (PRF), being rich sources of growth factors, have also come into widespread periodontal regenerative use. The aim of this study is to evaluate and compare efficacy of open flap debridement (OFD) with or without PRF or PRF + 1.2% RSV gel in treatment of intrabony defects (IBDs) in patients with chronic periodontitis (CP). METHODS Ninety individuals with a total of 90 IBDs were randomly assigned to one of three treatment groups: 1) OFD alone; 2) OFD + PRF; and 3) OFD + PRF + 1.2% RSV gel placement. Measurements recorded at baseline and 9 months after surgery were: 1) plaque index (PI); 2) modified sulcus bleeding index (mSBI); 3) probing depth (PD); 4) clinical attachment level (CAL); and 5) IBD depth. RESULTS Significant PI and mSBI reductions were observed in all three groups. PRF placement significantly enhanced improvements in periodontal parameters compared with OFD alone. Addition of 1.2% RSV gel to PRF resulted in significantly greater CAL gain and PD and IBD depth reductions over 9 months compared with other groups. CONCLUSION OFD with RSV (1.2%) and PRF results in significantly greater periodontal benefits compared with OFD alone or with PRF.
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Affiliation(s)
- A R Pradeep
- Department of Periodontology, Government Dental College and Research Institute, Bengaluru, Karnataka, India
| | - Vibhuti Garg
- Department of Periodontology, Government Dental College and Research Institute, Bengaluru, Karnataka, India
| | - Dharmendra Kanoriya
- Department of Periodontology, Government Dental College and Research Institute, Bengaluru, Karnataka, India
| | - Sandeep Singhal
- Department of Periodontology, Government Dental College and Research Institute, Bengaluru, Karnataka, India
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Morand DN, Davideau JL, Clauss F, Jessel N, Tenenbaum H, Huck O. Cytokines during periodontal wound healing: potential application for new therapeutic approach. Oral Dis 2016; 23:300-311. [PMID: 26945691 DOI: 10.1111/odi.12469] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/12/2016] [Accepted: 03/01/2016] [Indexed: 12/15/2022]
Abstract
Regeneration of periodontal tissues is one of the main goals of periodontal therapy. However, current treatment, including surgical approach, use of membrane to allow maturation of all periodontal tissues, or use of enamel matrix derivatives, presents limitations in their indications and outcomes leading to the development of new tissue engineering strategies. Several cytokines are considered as key molecules during periodontal destruction process. However, their role during each phase of periodontal wound healing remains unclear. Control and modulation of the inflammatory response and especially, release of cytokines or activation/inhibition in a time- and spatial-controlled manner may be a potential perspective for periodontal tissue engineering. The aim of this review was to summarize the specific role of several cytokines during periodontal wound healing and the potential therapeutic interest of inflammatory modulation for periodontal regeneration especially related to the expression sequence of cytokines.
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Affiliation(s)
- D N Morand
- INSERM (French National Institute of Health and Medical Research), UMR 1109, Osteoarticular and Dental Regenerative Nanomedicine Laboratory, Faculté de Médecine de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France.,Department of periodontology, Dental Faculty, University of Strasbourg, Strasbourg, France
| | - J-L Davideau
- INSERM (French National Institute of Health and Medical Research), UMR 1109, Osteoarticular and Dental Regenerative Nanomedicine Laboratory, Faculté de Médecine de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France.,Department of periodontology, Dental Faculty, University of Strasbourg, Strasbourg, France
| | - F Clauss
- INSERM (French National Institute of Health and Medical Research), UMR 1109, Osteoarticular and Dental Regenerative Nanomedicine Laboratory, Faculté de Médecine de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France.,Department of periodontology, Dental Faculty, University of Strasbourg, Strasbourg, France
| | - N Jessel
- INSERM (French National Institute of Health and Medical Research), UMR 1109, Osteoarticular and Dental Regenerative Nanomedicine Laboratory, Faculté de Médecine de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - H Tenenbaum
- INSERM (French National Institute of Health and Medical Research), UMR 1109, Osteoarticular and Dental Regenerative Nanomedicine Laboratory, Faculté de Médecine de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France.,Department of periodontology, Dental Faculty, University of Strasbourg, Strasbourg, France
| | - O Huck
- INSERM (French National Institute of Health and Medical Research), UMR 1109, Osteoarticular and Dental Regenerative Nanomedicine Laboratory, Faculté de Médecine de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France.,Department of periodontology, Dental Faculty, University of Strasbourg, Strasbourg, France
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Pradeep AR, Garg V, Kanoriya D, Singhal S. 1.2% Rosuvastatin Versus 1.2% Atorvastatin Gel Local Drug Delivery and Redelivery in Treatment of Intrabony Defects in Chronic Periodontitis: A Randomized Placebo-Controlled Clinical Trial. J Periodontol 2016; 87:756-62. [PMID: 26878748 DOI: 10.1902/jop.2016.150706] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) are an important group of hypolipidemic drugs that are able to modulate inflammation and alveolar bone loss. Rosuvastatin (RSV) and atorvastatin (ATV) are known to inhibit osteoclastic bone resorption and have been proposed to have osteostimulative properties. The aim of this study is to evaluate and compare the efficacy of 1.2% RSV and 1.2% ATV gel local drug delivery (LDD) and redelivery systems, in addition to scaling and root planing (SRP), for the treatment of intrabony defects (IBDs) in patients with chronic periodontitis (CP). METHODS A total of 90 individuals with 90 IBDs was randomly allocated to treatment with SRP followed by LDD of 1.2% RSV, 1.2% ATV, or placebo gel. Clinical and radiographic parameters, including plaque index (PI), modified sulcus bleeding index (mSBI), probing depth (PD), clinical attachment level (CAL), and IBD depth, were recorded at baseline and 6 and 9 months. RESULTS All three groups showed significant reduction in PI and mSBI at all intervals. Mean mSBI and PD reductions, CAL gain, and IBD depth reduction with statin drugs were significantly greater than with placebo gel LDD. Improvements in these parameters were significantly greater with RSV LDD than ATV or placebo gels at 6 and 9 months. CONCLUSION LDD of 1.2% RSV results in significantly greater clinico-radiographic improvement than 1.2% ATV or placebo gels as adjunct to mechanical periodontal therapy.
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Affiliation(s)
- A R Pradeep
- Department of Periodontology, Government Dental College and Research Institute, Bengaluru, Karnataka, India
| | - Vibhuti Garg
- Department of Periodontology, Government Dental College and Research Institute, Bengaluru, Karnataka, India
| | - Dharmendra Kanoriya
- Department of Periodontology, Government Dental College and Research Institute, Bengaluru, Karnataka, India
| | - Sandeep Singhal
- Department of Periodontology, Government Dental College and Research Institute, Bengaluru, Karnataka, India
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