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30 July 2019

Periodontitis: a new approach for angular intrabone defects

Alessandra Abbà


Resective and regenerative procedures are applied in security for the treatment of periodontal intrabony defects. The ultimate aim of periodontology is to regenerate damaged parodontal structures with biologically active endogenous proteins. Many studies have shown that the growth factors play an important role in periodontal healing and regeneration. For example, PRGF is an autologous preparation enriched with biological mediators that promote regeneration of both hard and soft tissues.   
Metformin (MF) is one of the most common oral hypoglycemic drugs used for the treatment of type II diabetes mellitus. Studies showed a direct osteogenic effect of MF on osteoblasts in culture.

The aim of this randomized controlled trial published on Journal of Dental  Research and Dental Clinics and Dental Prospects was to evaluate the effect of PRGF with 1% metformin biofilm in the treatment of two-wall intrabony periodontal defects.                          

MATERIALS AND METHODS 
This study was designed as a randomized, double‑blinded (patient, clinician) study. In this clinical trial, 8 patients (mean age 35 years) with moderate chronic periodontitis and two-wall intrabony defect were included. The defects were randomlyassigned to 4 groups: debridement, 1% metformin, PRGF, PRGF and metformin. Oral hygiene instruction, scaling and root planing (SRP) were provided to all the patients to achieve a satisfactory level of biofilm before surgery. All the surgical procedures were performed by the same person: intrasulcular incision with mucoperiosteal flap elevation, debridement of granulation tissue, subgingival SRP, and rinsing with normal saline solution. Then, the patients were assigned to the groups based on the predefined random allocation. The parameters of vertical probing depth, vertical clinical attachment level and gingival index were measured at baseline (T0), immediately before surgery (T1), and 3 (T2) and 6 months after surgery (T3). In addition, the radiographic changes were evaluated with digital subtraction radiography before and 6 months after surgery. Analysis of the results was performed with repeated measurements, Friedman test and chisquared test.   

RESULTS
Radiographic analysis showed statistically significant differences between MF and PRGF groups.‏ Data regarding clinical parameters exhibited  differences between the four study groups from T0 to T4 by repeated measurement test. Inter-group comparison of GI, CAL and PPD parameters did not revealed significant improvements. Nevertheless there were significant differences between the groups from the beginning to the end of treatment (P<0.001).  

CONCLUSIONS
Application of PRGF with 1% metformin in two-wall intrabony periodontal defects was effective in improving clinical parameters but not significantly different from other groups. Just radiographic ananlysis showed significant improvements.  


For additional informations: 
Clinical and radiographic evaluation of applying 1% metformin biofilm with plasma rich in growth factor (PRGF) for treatment of two-wall intrabony periodontal defects: A randomized clinical trial

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