CLINICAL EFFICACY OF METFORMIN & ALENDRONATE 1% GEL IN CHRONIC PERIODONTITIS

Abstract

Chronic periodontitis is a chronic inflammatory disease of periodontium. Bacterial plaque bio-film stimulates host derived enzymes and cytokines like TNFα leading to periodontal destruction. Conventional therapy of scaling and root planning (SRP) with or without systemic antimicrobials is often insufficient to treat chronic periodontitis. Local drug delivery systems are now considered more beneficial owing to direct access to target site which is often nonresponsive to conventional therapy. Metformin and Alendronate share osteostimulative and anti-inflammatory properties. Delivered intra-pocket in gel form offers a better approach for treating localized moderate chronic periodontitis. The objectives of present study were to evaluate and compare the clinical efficacy of Metformin and Alendronate 1% gel in adjunct to SRP in patients having moderate localized chronic periodontitis and to evaluate the superior drug among Metformin gel, Alendronate gel and control drug oral Doxycycline. In this single blind, randomized clinical trial, 84 systemically healthy, males and females aged 30-50 year, diagnosed with localized moderate chronic periodontitis were enrolled after written informed consent from Bahria Dental College Hospital. Patients were randomized by computerized list into three groups of 28 each. Group A (control) had SRP and prescribed tablet Doxycycline 200 mg stat and 100 mg OD for fourteen days, Group B and C received Metformin and Alendronate 1% gel intra-pocket respectively at day 0 with SRP and repeated drug if required at day 45. Clinical parameters (PPD, PI, CAL, mSBI) were evaluated at day 0, 45 and 90. Radiological parameters (VBL, IBDA, BMD, IBDDR) by OPG, biochemical marker (TNFα) by Elisa and anthropometric parameter (BMI) were evaluated at day 0 and 90. All patients were advised for non-vigorous brushing BD, no flossing and consumption of soft diet. In intra-group comparison all drugs produced highly significant effects on clinical parameters, non-significant effects on radiological parameters (with the exception of Metformin that produced significant effect on vertical bone loss), significant effect on biochemical parameter by Metformin and xi Alendronate both but more inclined towards Metformin and no effect on anthropometric parameter from day 0 to day 90. Overall within the groups Metformin has exerted more beneficial effects. Upon inter-group comparison between 1% Metformin and 1% Alendronate, former has produced more beneficial effects on clinical, biochemical and among the radiological parameters upon vertical bone loss in comparison to latter. Both drugs have produced similar and non-significant effects on the anthropometric parameter and other radiological parameters. 1% Metformin gel is more cost effective in comparison to 1% Alendronate gel. Among gels 1% Metformin has produced more beneficial effects in comparison to control group on clinical, radiological and biochemical parameters. Gels are more cost effective, safe and had no adverse effects. Gels are superior to Doxycycline specifically 1% Metformin gel. There is a difference between the clinical efficacy of 1% Metformin and 1% Alendronate gel in treatment of localized moderate chronic periodontitis. 1% Metformin gel is superior to oral Doxycycline and 1% Alendronate gel for treating patients with chronic periodontitis of localized moderate severity by having more beneficial effects and cost effectiveness.