Comparative evaluation of coenzyme Q10-based gel and 0.8% hyaluronic acid gel in treatment of chronic periodontitis

Can vitamins improve periodontal wound healing/regeneration?

Periodontitis is a complex inflammatory disorder of the tooth supporting structures, associated with microbial dysbiosis, and linked to a number if systemic conditions. Untreated it can result in an irreversible damage to the periodontal structures and eventually teeth loss. Regeneration of the lost periodontium requires an orchestration of a number of biological events on cellular and molecular level. In this context, a set of vitamins have been advocated, relying their beneficial physiological effects, to endorse the biological regenerative events of the periodontium on cellular and molecular levels. The aim of the present article is to elaborate on the question whether or not vitamins improve wound healing/regeneration, summarizing the current evidence from in vitro, animal and clinical studies, thereby shedding light on the knowledge gap in this field and highlighting future research needs. Although the present review demonstrates the current heterogeneity in the available evidence and knowledge gaps, findings suggest that vitamins, especially A, B, E, and CoQ10, as well as vitamin combinations, could exert positive attributes on the periodontal outcomes in adjunct to surgical or nonsurgical periodontal therapy.

Systematic Review on Protocols of Coenzyme Q10 Supplementation in Non-Surgical Periodontitis Therapy

This systematic review focuses on the different study protocols on CoQ10 as an adjunct in non-surgical periodontitis therapy. The study protocol was developed following PRISMA guidelines and was registered in PROSPERO (CRD42021156887). A sensitive search up to January 2022 considered MEDLINE via PubMed and Web of Science, Embase, Web of Science Core Collection via Web of Science, Google Scholar, Cochrane CENTRAL, WHO (ICTRP), ClinicalTrials.gov, and grey literature. Randomized controlled (SRP with/without placebo) clinical trials (RCTs) on all types of CoQ10 administration were included. The primary outcome was probing pocket depth (PPD). Secondary outcomes were bleeding on probing, clinical attachment loss, and gingival and plaque indices. Twelve RCTs with local and five with systemic CoQ10 administration were included. The study protocols were heterogeneous. Local CoQ10 administration was performed once or several times in a period up to 15 days. Systemic CoQ10 was applied twice or three times daily for six weeks up to four months. The reporting quality was low, including missing information about CoQ10 doses. Risk of bias was high or unclear. About half of the studies reported significant group differences for PPD. Until now, no statement on the effectiveness of CoQ10 in non-surgical periodontitis therapy is possible. Further high-quality RCTs are necessary and should consider the protocol recommendations of this review.

Comparative evaluation of efficacy of topical and intra-sulcular application of Co-enzyme Q10 in the non-surgical treatment of periodontal diseases

Background

Periodontitis is a ubiquitous and irreversible inflammatory condition that affects the supporting structures of teeth, which could lead to tooth loss as well as contribute to systemic inflammation. During the inflammatory phase, there is a release of superoxide ions and reactive oxygen species, which causes an increase in the oxidative stress. To combat this stress, the use of certain antioxidants has been proposed, which will help in maintaining the harmonious equilibrium.

Aim

The aim of the present systematic review is to investigate the efficacy of topical and intrasulcular application of coenzyme Q10 in nonsurgical treatment of periodontal disease.

Materials and Methods

We conducted a systematic review on the clinical studies which compared the use of coenzyme Q10 as an adjunct to nonsurgical periodontal therapy. The studies mentioned in this review were in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and met our inclusion criteria - only randomized control trials in humans and literature published between 2000 and 2020 were included.

Results

Therapies with coenzyme Q10 as an adjunct to scaling and root planing (SRP) proved to show superior improvement by reduction in the clinical parameters (plaque index, gingival index, bleeding on probing, and clinical attachment loss) when compared to SRP alone.

Conclusions

Adjunctive therapy with coenzyme Q10 provides longer-lasting therapeutic effects and better results when compared with SRP alone. The possibility to use the gel as a sole agent to support standard treatment procedures in periodontitis is also suggested.

Evaluation of Efficacy of Coenzyme Q10 as an Adjunct to Nonsurgical Periodontal Therapy and Its Effect on Crevicular Superoxide Dismutase in Patients with Chronic Periodontitis

OBJECTIVES

 To assess the efficacy of coenzyme Q10 (CoQ10) as an adjunct to nonsurgical periodontal therapy and its effect on superoxide dismutase (SOD) in gingival crevicular fluid (GCF) in patients with chronic periodontitis (CP).

MATERIALS AND METHODS

 A total of 16 patients aged between 30 and 50 years having mild to moderate CP of both sexes having pocket depth of 5 to 7 mm in four nonadjacent interproximal sites were selected. The sites were randomized and divided into treatment and control groups. CoQ10 and a placebo gel were administered in the treatment and control sites, respectively, at baseline after scaling and root planing (SRP). GCF was collected using microcapillary method at baseline and 3 months and was assessed for SOD using enzyme-linked immunosorbent assay reader at 450 nm wavelength. Probing pocket depth, gingival index, and plaque index were assessed at baseline, 1 month, and 3 months, respectively.

STATISTICAL ANALYSIS

 For each assessment point, data were statistically analyzed using Student's t-test and paired t-test. Level of significance was set at p < 0.05.

RESULTS

 On intergroup comparison, there was no statistically significant difference between the clinical parameters of both the groups at all the time intervals (p > 0.05), but there was a significant increase in the level of SOD in the test group (p > 0.05) compared with the control group at 3 months.

CONCLUSIONS

 Adjunctive use of CoQ10 with SRP can boost the antioxidant concentration, but it is not superior to SRP in the treatment of CP.

Effect of micronutrient malnutrition on periodontal disease and periodontal therapy

Periodontitis is a complex chronic inflammatory noncommunicable disease, initiated by the development of a dysbiotic microbial plaque biofilm below the gingival margin. Whilst the pathogenic biofilm is a "necessary cause" of periodontitis, it is insufficient on its own to cause the disease, and a destructive immune-inflammatory response is a key to the translation of risk to destructive events. Other exposures or "component causes" include individual genetic predisposition, lifestyle (including smoking and nutrition), and environmental factors. Dietary nutrients are essential for life as they provide crucial energy sources in the form of macronutrients, as well as important cofactors in the form of micronutrients, which regulate the functionality of enzymes during the regulation of anabolic and catabolic processes in human cells. Moreover, micronutrients can regulate gene transcription factors, such as the proinflammatory nuclear factor kappa B and the anti-inflammatory nuclear factor (erythroid-derived 2)-like 2. This review focuses on the role of vitamins (vitamin A, carotenoids, the vitamin B complex, vitamins C, D, and E, and coenzyme Q10) and minerals (calcium, magnesium, iron, zinc, potassium, copper, manganese, and selenium) in human physiology and the impact of their deficiencies upon periodontal health and disease.

Subgingivally delivered coenzyme Q10 in the treatment of chronic periodontitis among smokers: A randomized, controlled clinical study

Background

Coenzyme Q10 is an antioxidant whose efficacy in periodontal diseases is well known. However studies regarding its efficacy in smokers with periodontitis are few. Coenzyme Q10 serves as an endogenous antioxidant and its increased concentration in the diseased gingiva effectively suppresses advanced periodontal inflammation.

Objectives

The aim of this study is to evaluate the efficacy of coenzyme Q10 as an adjunct to scaling and root planing in smokers with chronic periodontitis.

Methods

Total of 40 patients were enrolled for the study. The subjects were divided into control (Scaling and root planing only) and test group (Coenzyme Q10 plus Scaling and root planing). Clinical parameters such as plaque index, modified sulcular bleeding index, probing pocket depth and clinical attachment level. These were assessed at baseline, at 1 month and 3 month. The results were subjected to appropriate statistical analysis.

Results

There was a significant improvement in all clinical parameters in the test sites seen at the end of the 1 month and 3 month period.

Conclusions

Coenzyme Q10 can be said to have a beneficial effect on smokers with periodontitis when used as an adjunct to scaling and root planing.

Intraoral fibrolipoma: case report and review of literature

Introduction: Lipomas are benign soft tissue tumors, characterized by the presence of mature adipocytes in histopathology. Their development is slow and their etiologies are still controversial. Frequently subcutaneous, this type of lesion is rarely present in the oral cavity. Observation: A 67-year-old man consulted for a nodule on the inner face of his right cheek which had been developing for several years, with severe discomfort during chewing. The typical clinical aspect of this lesion suggested a lipoma. Magnetic resonance imaging (MRI) was performed before surgical excision in order to establish a differential diagnosis with a well-differentiated liposarcoma. Comments: The various imaging examinations, particularly MRI, combined with the analysis of the fat component and the morphology of the non-fat component (septa) enable us to define several categories of lesions likely to have a benign or malignant character. However, some lesions remain difficult to classify, and it is the histopathological examination along with, if necessary, immunohistochemistry (anti-MDM2 and/or anti-CDK4), which allows to confirm or not the malignancy of a lesion. Histological examination suggested a fibrolipoma. Conclusion: Although benign, the size of a fibrolipoma may can lead to significant functional and aesthetic discomfort for the patient. Surgical excision remains the treatment of choice.