Efficacy of locally‐delivered 1% metformin gel in the treatment of intrabony defects in patients with chronic periodontitis: a randomized, controlled clinical trial

Pradeep, A.R.; Patnaik, Kaushik; Nagpal, Kanika; Karvekar, Shruti; Ramamurthy, Bhaskar L.; Naik, Savitha B.; Suke, Deepak Kumar; Singh, Priyanka; Raju, Arjun

doi:10.1111/jicd.12150

Cited by 33 publications

(57 citation statements)

References 35 publications

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“…All clinical studies were RCTs . In all studies, number of subjects ranged between 20 and 70 individuals with age ranging between 25 and 55 years.…”

Section: Resultsmentioning

confidence: 99%

“…In all studies, number of subjects ranged between 20 and 70 individuals with age ranging between 25 and 55 years. The number of patients lost at follow‐up ranged from 0 to 4 patients in the included studies . All studies reported the percentage of female participants, which ranged between 0% and 51%.…”

Section: Resultsmentioning

confidence: 99%

“…In 4 studies, subjects in the control group used SRP with placebo gel, while 1 study utilized SRP alone. Three studies used 1% locally delivered metformin, while 1 study utilized 0.6% metformin multiple layers film and another used varying concentrations such as 0.5%, 1% and 1.5% metformin for treating periodontal defects. One study recruited smokers, while 1 did not mention anything about tobacco users.…”

Section: Resultsmentioning

confidence: 99%

“…Risk of bias was evaluated by extracting the data for each trial and presented in Table . Randomization: All included studies were RCTs but 2 did not report randomization and allocation methods in detail. Three trials presented an adequate method randomization.…”

Section: Resultsmentioning

confidence: 99%

“…These include systemic and localized delivery of antibiotics, bisphosphonates, lasers and photodynamic therapy to reduce bacterial counts and improve clinical periodontal parameters such as probing depth reduction, gaining clinical attachment level and bone defect (BD) fill in periodontitis . Among these compounds, locally delivered metformin have recently been introduced for the treatment of periodontal bone defects in chronic periodontitis …”

Section: Introductionmentioning

confidence: 99%

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Locally delivered metformin as adjunct to scaling and root planing in the treatment of periodontal defects: A systematic review and meta‐analysis

Akram

Vohra

Javed

2018

J of Periodontal Research

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This study aimed to evaluate the efficacy of metformin as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis. Electronic searches were conducted in databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Cochrane Oral Health Group Trials Register databases) up to August 2017. Randomized clinical trials with data in comparison between adjunctive locally delivered metformin use to SRP and placebo in each group and a follow-up period of at least 6 months, were included. Primary outcomes included clinical attachment level, while secondary outcomes were bone defect (BD) fill and reduction in probing depth. The weighted mean differences (WMD) of outcomes and 95% confidence intervals (CI) for each variable were calculated using the random effects model. Five clinical studies were included in the qualitative synthesis and 3 studies were included for meta-analysis. All the included studies showed significant BD fill, probing depth reduction and clinical attachment level gain with adjunctive locally delivered metformin compared to SRP alone. Considering the effects of adjunctive metformin as compared to SRP, a high degree of heterogeneity for BD fill (Q value = 7.03, P = .02, I = 71.55%) was noticed among both the groups. Meta-analysis showed a statistically significant clinical attachment level gain (WMD = -2.83, 95% CI = -3.32 to -2.34, P < .001), BD fill (WMD = -2.96, 95% CI = -3.99 to -1.93, P < .001) and probing depth reduction (WMD = -3.11, 95% CI = -3.63 to -2.59, P < .001) for SRP + metformin treatment vs SRP. Adjunctive use of metformin delivery in periodontal treatment appears to be effective in BD fill, reducing probing depth and gain in clinical attachment level. Further multicentered randomized clinical trials are warranted in future to prove additional benefits of metformin as an adjunct to SRP in the treatment of chronic periodontitis.

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“…All clinical studies were RCTs . In all studies, number of subjects ranged between 20 and 70 individuals with age ranging between 25 and 55 years.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Locally delivered metformin as adjunct to scaling and root planing in the treatment of periodontal defects: A systematic review and meta‐analysis

Akram

Vohra

Javed

2018

J of Periodontal Research

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Metformin facilitates the proliferation, migration, and osteogenic differentiation of periodontal ligament stem cells in vitro

Zhang

Liang

Kang

et al. 2019

Cell Biology International

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Periodontitis is one of the main causes of tooth loss and has been confirmed as the sixth complication of diabetes. Metformin promotes the osteogenic differentiation of stem cells. Periodontal ligament stem cells (PDLSCs) are the best candidate stem cells for periodontal tissue regeneration. Herein, we aimed to identify the effects of metformin on the proliferation, migration, and osteogenic differentiation of PDLSCs in vitro. PDLSCs were isolated by limiting dilution, and their characteristics were assessed by colony formation assay and flow cytometry. Cell counting and migration assays were used to investigate the effects of metformin on proliferation and migration. The osteogenic differentiation ability of PDLSCs was detected by alkaline phosphatase (ALP) activity and Alizarin Red S staining. Gene and protein levels of osteogenesis‐related markers were determined by quantitative real‐time polymerase chain reaction (qRT‐PCR) and western blot analysis, respectively. Metformin treatment at 10 μM did not affect PDLSC proliferation, while at 50 and 100 μM, metformin time‐dependently enhanced PDLSC proliferation and significantly increased cell numbers after 5 and 7 days of stimulation (P < 0.05). In addition, 50 μM metformin exhibited a maximal effect on migration, ALP activity, and mineral deposition (P < 0.05). Furthermore, 50 μM metformin significantly upregulated the gene expression levels of ALP, BSP, OPN, OCN, and Runx2 and the protein expression of ALP and Runx2 (P < 0.05). In summary, our study confirms that metformin facilitates the proliferation, migration, and osteogenic differentiation of PDLSCs in vitro and could be used as a new strategy for periodontal tissue regeneration.

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Diabetes pharmacotherapy and effects on the musculoskeletal system

Kalaitzoglou

Fowlkes

Popescu

et al. 2018

Diabetes Metabolism Res

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Summary Persons with type 1 or type 2 diabetes have a significantly higher fracture risk than age‐matched persons without diabetes, attributed to disease‐specific deficits in the microarchitecture and material properties of bone tissue. Therefore, independent effects of diabetes drugs on skeletal integrity are vitally important. Studies of incretin‐based therapies have shown divergent effects of different agents on fracture risk, including detrimental, beneficial, and neutral effects. The sulfonylurea class of drugs, owing to its hypoglycemic potential, is thought to amplify the risk of fall‐related fractures, particularly in the elderly. Other agents such as the biguanides may, in fact, be osteo‐anabolic. In contrast, despite similarly expected anabolic properties of insulin, data suggests that insulin pharmacotherapy itself, particularly in type 2 diabetes, may be a risk factor for fracture, negatively associated with determinants of bone quality and bone strength. Finally, sodium‐dependent glucose co‐transporter 2 inhibitors have been associated with an increased risk of atypical fractures in select populations, and possibly with an increase in lower extremity amputation with specific SGLT2I drugs. The role of skeletal muscle, as a potential mediator and determinant of bone quality, is also a relevant area of exploration. Currently, data regarding the impact of glucose lowering medications on diabetes‐related muscle atrophy is more limited, although preclinical studies suggest that various hypoglycemic agents may have either aggravating (sulfonylureas, glinides) or repairing (thiazolidinediones, biguanides, incretins) effects on skeletal muscle atrophy, thereby influencing bone quality. Hence, the therapeutic efficacy of each hypoglycemic agent must also be evaluated in light of its impact, alone or in combination, on musculoskeletal health, when determining an individualized treatment approach. Moreover, the effect of newer medications (potentially seeking expanded clinical indication into the pediatric age range) on the growing skeleton is largely unknown. Herein, we review the available literature regarding effects of diabetes pharmacotherapy, by drug class and/or by clinical indication, on the musculoskeletal health of persons with diabetes.

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Efficacy of locally‐delivered 1% metformin gel in the treatment of intrabony defects in patients with chronic periodontitis: a randomized, controlled clinical trial

Abstract: One percent MF was found to significantly improve clinical and radiographic parameters in intrabony defects in patients with chronic periodontitis.

Cited by 33 publications

References 35 publications

Locally delivered metformin as adjunct to scaling and root planing in the treatment of periodontal defects: A systematic review and meta‐analysis

Locally delivered metformin as adjunct to scaling and root planing in the treatment of periodontal defects: A systematic review and meta‐analysis

Metformin facilitates the proliferation, migration, and osteogenic differentiation of periodontal ligament stem cells in vitro

Diabetes pharmacotherapy and effects on the musculoskeletal system

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