Study on the Effects of Melatonin on Glycemic Control and Periodontal Parameters in Patients with Type II Diabetes Mellitus and Periodontal Disease

Expression of MMP-14 and CD147 in Gingival Tissue of Patients With and Without Diabetes Mellitus Type II

Background: Diabetes mellitus (DM) is a major risk factor for the development of periodontal disease and aggravates the severity of periodontal conditions. Matrix metalloproteinases (MMPs) are known to degrade periodontal ligament attachment and bone matrix proteins. Increased expression of CD147 is associated with increased synthesis of several MMPs, being a modulator of MMP expression, including that of MMP-14. The purpose of this study was to quantify and compare the expressions of MMP-14 and CD147 in gingival tissues of patients with and without type 2 diabetes mellitus. Material and Methods: In this histological study, we included 33 subjects with periodontal disease: 16 patients with type 2 DM (test group) and 17 systemically healthy patients (control group). Tissue fragments were processed using an immunohistochemistry technique to determine immunoreactivity (IR) intensity of MMP-14 and CD147. Results: In the group of diabetes patients with periodontitis, 56.2% showed weak positive expressions (+), while 43.8% had intensely positive expressions (+++) of MMP-14. Statistically significant differences between test and control groups (p = 0.004, p = 0.883, and p = 0.002) were found for the membranous IR intensity of MMP-14. In the group of diabetes patients with periodontitis, 56.2% had moderate positive expressions (++) of CD 147, while 43.8% showed intensely positive expressions (+++). Statistically significant differences between the test and control groups were found (p = 0.001, p = 0.002, and p = 0.003) for the membranous IR intensity of CD147. Conclusions: The significantly higher membranous IR intensity for MMP-14 and CD 147 demonstrates the role of these biomarkers in the development of periodontal pathology in diabetes patients. It can be assumed that MMP-14 and CD147 could be further investigated as potential predictive biomarkers.

Impact of Melatonin Supplementation on Glycemic Parameters in Patients with Type 2 Diabetes: A Systematic Review and Meta-analysis

BACKGROUND

Several previous studies indicated that melatonin supplementation may positively affect glycemic control in patients with diabetes. However, research on the influence of melatonin supplementation on glycemic parameters remains inconclusive. Therefore, this study aimed to assess the impacts of melatonin supplementation on glycemic parameters in type 2 diabetes by conducting a meta-analysis.

METHODS

PubMed/Medline, Scopus, and Web of Science were comprehensively searched until July 2024 to find eligible randomized clinical trials (RCTs). The overall effect sizes were estimated by using the randomeffect model and presented as weighted mean differences (WMD) with a 95% confidence interval (CI). Furthermore, the heterogeneity among the included trials was assessed by performing the Cochran Q test and interpreted based on the I² statistic.

RESULTS

Of the 1361 papers, eight eligible RCTs were included in this meta-analysis. Our findings indicated that melatonin supplementation significantly decreased fasting blood glucose (WMD = -12.65 mg/dl; 95% CI: -20.38, -4.92; P = 0.001), insulin (WMD = -2.30 μU/ml; 95% CI: -3.20, -1.40; P < 0.001), hemoglobin A1c (WMD = -0.79 %; 95% CI: -1.28, -0.29; P = 0.002), and HOMA-IR (WMD, -0.83; 95% CI: -1.59 to - 0.07; P = 0.03).

CONCLUSION

According to the results of the current meta-analysis, persons with type 2 diabetes who supplement with melatonin had improved glycemic control. It looks that supplementing with melatonin at a dose exceeding 6 mg daily for over a period of 12 weeks may be more successful than other forms of intervention. Nevertheless, further research with larger sample sizes is necessary to draw definitive conclusions.

Clinical and Microbiological Periodontal Biofilm Evaluation of Patients with Type I Diabetes

Background/Objectives: The purpose of this study was to assess the microbial composition and density of subgingival plaque samples for periodontal pathogens while correlating the values with glycemic control levels via glycated hemoglobin (HbA1c), a type of hemoglobin that has chemically linked glucose, in type I diabetes individuals who will undergo complex oral rehabilitation through orthodontic treatment and implant surgery. Methods: A cohort of 42 adults with type I diabetes were included in this study. The subjects sustained a comprehensive periodontal clinical examination as well as microbiological assessments of their subgingival plaque samples through quantitative real-time PCR. The samples were collected from the two deepest pockets of each subject. Results: The highest number of periodontopathogenic bacteria was observed in the pockets of 5-7 mm. T. forsythia showed the highest prevalence (20.48%), with decreasing numbers as follows: T. denticola (13.31%), P. gingivalis (11.26%), A. actinomycetemcomitans (7%), and P. intermedia (4.9%). T. denticola and T. forsythia were significantly more commonly observed in individuals with elevated HbA1c serum levels. No correlation was observed between P. gingivalis, A. actinomycetemcomitans, P. intermedia presence, and the HbA1c value. Conclusions: Periodontopathogenic agents' presence in subgingival biofilm samples varied in accordance with the pocket probing depth and metabolic control of the diabetic individuals. In our study, the appearance of these periodontopathogenic agents was linked to lowered metabolic control in patients with type I diabetes mellitus.

Systemic Factors Affecting Prognosis and Outcomes in Periodontal Disease

This review delves into the effects of autoimmune conditions like rheumatoid arthritis, inflammatory disorders such as irritable bowel syndrome, cardiovascular disease, diabetes, infectious ailments like human immunodeficiency virus, and their medications on periodontal therapy outcomes. It also explores the influence of hormones. Understanding these systemic factors is crucial for optimizing periodontal health and treatment efficacy. The review underscores the necessity of considering these variables in periodontal care. Other vital systemic factors are addressed elsewhere in this special edition.

Assessment of Periodontitis Risk Factors in Endodontically Treated Teeth: A Cross-Sectional Study

The aim of the study was to collect data about the prevalence and risk factors of apical periodontitis in a population of endodontically treated patients. The study group included 151 patients (52 males, 99 females; mean age 48.36 ± 15.708 yrs.) with 391 endodontically treated teeth (mean follow-up of 5.25 ± 1.759 yrs.). According to the initial tooth diagnosis, root-filled teeth were divided into Group A, root-filled teeth treated for pulpitis or for the purpose of prosthetic pulpectomies (vital pulp group), and Group B, root-filled teeth with non-vital pulp (necrotic pulp). Clinical and radiographic evaluation of the root and its periapical area were performed to establish the success/failure of endodontic therapy, the quality of the root canal fillings (length, density, taper), and coronal restoration. The presence of recurrent caries, periodontal pathology, or endo-periodontal lesions were also recorded. Univariate and multivariate analyses were used to determine the risk factors for apical periodontitis and calculate their odds ratios (ORs). For the root-filled vital pulp tooth group, the highest risks for apical periodontitis are associated with inadequate homogeneity (OR 30.938), periodontitis (OR 9.226), and over-filling (OR 8.800). For the root-filled non-vital pulp tooth group, the highest risks are associated with periodontitis (OR 4.235) and age over 60 yrs. (OR 4.875). For the necrotic pulp tooth group, multivariate analysis identified an age > 60 yrs., filled molars, intracanal posts, poor coronal restoration quality, under-filling, and periodontitis as significant combined risk factors. Inadequate root canal filling and periodontitis in both groups were risk factors associated with most cases of apical periodontitis. Other risk factors include age > 60 yrs., poor coronal restoration quality, and the presence of intracanal posts in root-filled teeth with necrotic pulp.

Melatonin supports nonsurgical periodontal treatment in patients with Type 2 diabetes mellitus and periodontitis: A randomized clinical trial

BACKGROUND

Diabetes mellitus (DM)-associated hyperinflammatory host response significantly provokes periodontal tissue destruction. In this context, the support of nonsurgical periodontal therapy in diabetics with host modulation agents is a current field of study. This clinical study aims to investigate the clinical efficacy of melatonin supplementation and discuss its possible biological mechanisms in nonsurgical periodontal treatment in patients with DM and periodontitis through some fundamental markers.

METHODS

In this randomized controlled and single-blind study, 27 of 55 diabetic patients with periodontitis (stage III/IV and grade C) underwent full-mouth scaling and root planing (fmSRP) alone and 28 patients underwent melatonin administration (6 mg daily, 30 days) in addition to fmSRP (full-mouth scaling and root planing plus melatonin, fmSRP-mel). The potential therapeutic contribution of melatonin was evaluated clinically and biochemically (gingival crevicular fluid RANKL, OPG, MMP-8, and serum IL-1β levels) at 3rd and 6th months.

RESULTS

Melatonin (tablet, 6 mg daily, 30 days) did not cause any local or systemic side effects. fmSRP alone resulted in significant reduction in serum IL-1β levels, pocket depths, gingival inflammation, and gingival crevicular fluid RANKL and MMP-8 levels (p < 0.05). Moreover, melatonin supplementation resulted in a more significant decrease in bleeding and pocket depth scores at probing, especially at 3 months (p < 0.05). Furthermore, RANKL and MMP-8 levels were significantly lower at 3 months and IL-1β levels at 6 months compared to the control group (p < 0.05). However, OPG levels were not affected significantly by the treatments (p > 0.05).

CONCLUSION

Melatonin, as a host modulation agent, significantly increases the clinical efficacy of fmSRP. The reduction in periodontal inflammation and pocket depths may be a result of marked suppression of RANKL-associated osteoclastogenesis and extracellular matrix damage by melatonin.

Impact of Photobiomodulation and Melatonin on Periodontal Healing of Periodontitis in Immunosuppressed Rats

Introduction: Periodontitis is an inflammatory disease due to bacterial origin; it has a chronic course and progresses by immunosuppressive therapy. However, adjuvant therapies such as photobiomodulation (PBM) and melatonin can reduce the severity of the inflammation and inhibit the progression of periodontitis. Therefore, the present study evaluated the effects of PBM (PBM) and melatonin, as adjuvant therapies, on periodontal healing in immunosuppressed rats with periodontitis. Methods: Random allocation was performed on 36 albino Wistar rats, divided into the following groups: control, periodontitis, immunosuppressant only, immunosuppressant+PBM, immunosuppressant+melatonin, and immunosuppressant+melatonin+PBM. Periodontitis caused by ligature in all groups, except for the control group. Subcutaneous administration of dexamethasone was performed in the immunosuppressant groups for immunosuppression. All the groups except the control group received scaling and root planning (SRP). Each group was subdivided into three equal subgroups according to the evaluation period: (A), one week, (B) two weeks (C), 4 weeks. Histological examination was done with haematoxylin & eosin and Masson's Trichrome for inflammation and periodontal healing. Statistical Analysis of the data was done by using the chi-square test. The significance level was set at P≤0.05. Results: Regarding the inflammatory response and periodontal healing, histological examination revealed statistically significant difference in all treated groups in comparison with the control untreated immunosuppressed group (P<0.001). The combined application of melatonin and PBM resulted in a best histological response presented by lower inflammatory response and better periodontal healing, when compared with all other treated groups (P<0.001). Conclusion: After considering the circumstances of this research, the combination of melatonin and PBM by a 650 nm diode laser with output power of 100 mw for one minute for three sessions appeared to be a beneficial adjunct in periodontal healing in immunosuppressed rats with periodontitis.

Integrating network pharmacology and experimental evaluation to explore the complementary therapeutic effect and mechanism of melatonin in periodontitis

Objective

To explore the potential targets for melatonin in the treatment of periodontitis through network pharmacologic analysis and experimental validation via in vivo animal models and in vitro cellular experiments.

Materials and methods

In this study, we first screened melatonin targets from Pharm Mapper for putative targets, Drug Bank, and TCMSP databases for known targets. Then, disease database was searched and screened for differential expressed genes associated with periodontitis. The intersection of disease and melatonin-related genes yielded potential target genes of melatonin treatment for periodontitis. These target genes were further investigated by protein-protein interaction network and GO/KEGG enrichment analysis. In addition, the interactions between melatonin and key target genes were interrogated by molecular docking simulations. Then, we performed animal studies to validate the therapeutic effect of melatonin by injecting melatonin into the peritoneal cavity of ligation-induced periodontitis (LIP) mice. The effects of melatonin on the predicted target proteins were also analyzed using Western blot and immunofluorescence techniques. Finally, we constructed an in vitro cellular model and validated the direct effect of melatonin on the predicted targets by using qPCR.

Results

We identified 8 potential target genes by network pharmacology analysis. Enrichment analysis suggests that melatonin may treat periodontitis by inhibiting the expression of three potential targets (MPO, MMP8, and MMP9). Molecular docking results showed that melatonin could effectively bind to MMP8 and MMP9. Subsequently, melatonin was further validated in a mouse LIP model to inhibit the expression of MPO, MMP8, and MMP9 in the periodontal tissue. Finally, we verified the direct effect of melatonin on the mRNA expression of MPO, MMP8, and MMP9 in an in vitro cellular model.

Conclusions

Through a combination of network pharmacology and experimental validation, this study provides a more comprehensive understanding of the mechanism of melatonin to treat periodontitis. Our study suggests that MPO, MMP8, and MMP9 as key target genes of melatonin to treat periodontitis. These findings present a more comprehensive basis for further investigation into the mechanisms of pharmacological treatment of periodontitis by melatonin.

Melatonin and oral diseases: possible therapeutic roles based on cellular mechanisms

Oral diseases, including periodontal disorders, oral cancer, periodontitis, and mucositis are the major challenges for both patients and healthcare providers. These conditions often involve inflammation, oxidative stress, and impaired cellular processes, leading to symptoms ranging from discomfort to severe debilitation. Conventional treatments for such oral diseases exhibit constraints, prompting the investigation of innovative therapeutic approaches. Considering the anti-inflammatory, anti-oxidant, and anti-cancer effects of melatonin, this study was carried out to investigate the potential protective effects of melatonin in mitigating the severity of oral diseases. Studies indicate that melatonin influences the differentiation of periodontal stem cells, inhibits oral cancer progression, reduces inflammation associated with periodontitis, and alleviates the severity of oral mucositis. Melatonin has demonstrated potential efficacy in both preclinical and clinical investigations; however, findings are frequently heterogeneous and contingent upon contextual factors. This review provides a comprehensiveoverview of current state of knowledge in this domain, elucidating the multifaceted role that melatonin may assume in combatingoral diseases. Further research should be directed toward determining the most effective dosing, timing, and administration methods for melatonin-based therapies for oral diseases.

Melatonin as a Chronobiotic and Cytoprotector in Non-communicable Diseases: More than an Antioxidant

A circadian disruption, manifested by disturbed sleep and low-grade inflammation, is commonly seen in noncommunicable diseases (NCDs). Cardiovascular, respiratory and renal disorders, diabetes and the metabolic syndrome, cancer, and neurodegenerative diseases are among the most common NCDs prevalent in today's 24-h/7 days Society. The decline in plasma melatonin, which is a conserved phylogenetic molecule across all known aerobic creatures, is a constant feature in NCDs. The daily evening melatonin surge synchronizes both the central pacemaker located in the hypothalamic suprachiasmatic nuclei (SCN) and myriads of cellular clocks in the periphery ("chronobiotic effect"). Melatonin is the prototypical endogenous chronobiotic agent. Several meta-analyses and consensus studies support the use of melatonin to treat sleep/wake cycle disturbances associated with NCDs. Melatonin also has cytoprotective properties, acting primarily not only as an antioxidant by buffering free radicals, but also by regulating inflammation, down-regulating pro-inflammatory cytokines, suppressing low-grade inflammation, and preventing insulin resistance, among other effects. Melatonin's phylogenetic conservation is explained by its versatility of effects. In animal models of NCDs, melatonin treatment prevents a wide range of low-inflammation-linked alterations. As a result, the therapeutic efficacy of melatonin as a chronobiotic/cytoprotective drug has been proposed. Sirtuins 1 and 3 are at the heart of melatonin's chronobiotic and cytoprotective function, acting as accessory components or downstream elements of circadian oscillators and exhibiting properties such as mitochondrial protection. Allometric calculations based on animal research show that melatonin's cytoprotective benefits may require high doses in humans (in the 100 mg/day range). If melatonin is expected to improve health in NCDs, the low doses currently used in clinical trials (i.e., 2-10 mg) are unlikely to be beneficial. Multicentre double-blind studies are required to determine the potential utility of melatonin in health promotion. Moreover, melatonin dosage and levels used should be re-evaluated based on preclinical research information.

Nutritional Modulation of Periodontal Diseases: A Narrative Review of Recent Evidence

The role of nutrition in managing periodontal diseases is a dynamic and evolving area of study. This review presents an in-depth analysis of various nutritional elements, including essential fatty acids, proteins, vitamins (D, E, and C), coenzyme Q10, melatonin, and probiotics, and their impact on periodontal health. It synthesizes findings from randomized clinical trials and observational studies to highlight the multifaceted influence of these nutrients on periodontal disease management. Key areas of focus include their role in reducing inflammation, altering the composition of the oral microbiota, and enhancing tissue repair and bone health. The review consistently points to the potential benefits of these nutrients, either as standalone agents or in conjunction with standard periodontal treatments, offering valuable insights for both clinicians and researchers. It advocates for a more nutritionally informed approach to periodontal disease management, emphasizing the importance of a well-rounded, preventive, and therapeutic strategy in dental health.

Diabetes mellitus promotes susceptibility to periodontitis-novel insight into the molecular mechanisms

Diabetes mellitus is a main risk factor for periodontitis, but until now, the underlying molecular mechanisms remain unclear. Diabetes can increase the pathogenicity of the periodontal microbiota and the inflammatory/host immune response of the periodontium. Hyperglycemia induces reactive oxygen species (ROS) production and enhances oxidative stress (OS), exacerbating periodontal tissue destruction. Furthermore, the alveolar bone resorption damage and the epigenetic changes in periodontal tissue induced by diabetes may also contribute to periodontitis. We will review the latest clinical data on the evidence of diabetes promoting the susceptibility of periodontitis from epidemiological, molecular mechanistic, and potential therapeutic targets and discuss the possible molecular mechanistic targets, focusing in particular on novel data on inflammatory/host immune response and OS. Understanding the intertwined pathogenesis of diabetes mellitus and periodontitis can explain the cross-interference between endocrine metabolic and inflammatory diseases better, provide a theoretical basis for new systemic holistic treatment, and promote interprofessional collaboration between endocrine physicians and dentists.

Review on the effect of systemic melatonin in periodontal disease

It is of interest to determine the efficacy of adjunctive systemically administered (via oral route) melatonin compared to a placebo, on changes in clinical parameters in patients with periodontitis undergoing periodontal therapy. Literature search was performed systematically after searching with 4 electronic databases until December 2022. Primary outcome measures were changes in Probing Pocket Depth (PPD) and bleeding on probing (BOP%). Secondary outcome measures taken were Clinical attachment Level (CAL) gain and level of Tumor Necrosis Factor-alpha (TNF-α). Risk of bias analysis was done for all the studies. With the adjunctive use of melatonin, improved probing depth reduction and gain in clinical attachment levels was observed in all four studies and was found to be statistically significant compared to the placebo group, suggesting that melatonin administered systemically was able to exert a positive effect at diseased sites. Melatonin drug administered at 10 mg dosage for 2 months showed a significant decrease in TNF-α levels; but showed no significant difference between TNF-α levels in the test and control group at 6 mg administration for 2 months. Systemically administered melatonin as an adjunct in treating periodontal disease could potentially be used due to its antioxidant, anti-inflammatory and bone remodelling properties from increasing evidence. However, a lack of proper guidelines, side effects, standardization of dosage for treating periodontitis and its long-term effect on various other systems in the body, patient related outcome factors and the effect of increased dietary melatonin efficacy have yet to be taken into consideration. Due to the lack of homogeneity, differences in dosage uniformity, and varying follow up intervals, more randomized controlled trial protocols are required to fill the lacunae and better improve our understanding.

Association between Clinical Periodontal Features and Glycated Hemoglobin in Patients with Diabetes and Controlled Periodontitis: A Cross-Sectional Study

Diabetes and periodontitis are the most prevalent chronic diseases, and they influence each other's progression. Only a few studies have shown the association between diabetes and mild periodontitis. We aimed to investigate the relationship between well-controlled periodontitis and glycated hemoglobin (HbA1c) in patients with diabetes. This retrospective study investigated 150 Japanese patients with type 2 diabetes treated with supportive periodontal therapy (SPT). Medical histories of diabetes and periodontal therapy were collected, and a multiple linear regression analysis was performed to determine their association. The patients included 67 (44.7%) males and 83 (55.3%) females, with a mean age of 68.1 (standard deviation = 10.5) years. Forty-four (29.3%) patients were treated for diabetes, and the mean HbA1c was 6.7% (0.7). Oral status was 23.3 (5.1) for the number of teeth, 2.5 mm (0.4) for mean probing pocket depth (PPD), and 163.9 mm2 (181.3) for the periodontal inflamed surface area (PISA). The multiple regression analysis showed a significant association between mean PPD (β = 0.38, p = 0.03) and HbA1c in patients with mild diabetes but not in severe cases. These results suggest that the diagnostic indices for periodontitis used to assess the association between periodontitis and HbA1c would be determined based on the severity of periodontitis and type 2 diabetes.

Beneficial Effects of Melatonin on Periodontitis Management: Far More Than Oral Cavity

Periodontitis as a highly prevalent chronic infection/inflammatory disease can eventually lead to tooth loss and masticatory dysfunction. It also has a negative impact on general health and largely impairs quality of life. The tissue destruction during periodontitis is mainly caused by the excessive immune-inflammatory response; hence, how to modulate the host's reaction is of profound importance for effective periodontal treatment and tissue protection. Melatonin, as an endogenous hormone exhibiting multiple biological functions such as circadian rhythm regulation, antioxidant, and anti-inflammation, has been widely used in general healthcare. Notably, the past few years have witnessed increasing evidence for the application of melatonin as an adjunctive approach in the treatment of periodontitis and periodontitis-related systemic comorbidities. The detailed underlying mechanisms and more verification from clinical practice are still lacking, however, and further investigations are highly required. Importantly, it is essential to establish standard guidelines in the near future for the clinical administration of melatonin for periodontal health and general wellbeing.

Effect of Injectable Platelet-Rich Fibrin with a Nano-Hydroxyapatite Bone Graft on the Treatment of a Grade II Furcation Defect

Background: Periodontal diseases lead to bone loss, crestal defects and even loss of the tooth, which also further makes it difficult to replace the tooth. Autogenous bone grafts are considered the gold standard in bone regenerative procedures. This study aimed to compare and evaluate the bone regenerative effects of i-PRF (Injectable- Platelet-rich fibrin) with a bone graft and a bone graft alone in mandibular grade II furcation defects over a period of 9 months. Method: This was a comparative study of 12 participants, who were randomly selected and grouped into two groups: test and control. Following phase I therapy, both groups were subjected to open flap debridement. In the test group, after debridement, a nano-hydroxyapatite bone graft mixed with i-PRF was inserted, whereas in the control group only a nano-hydroxyapatite bone graft was inserted. The clinical parameters such as plaque index (PI), gingival index (GI), pocket probing depth (PPD), clinical attachment level (CAL), horizontal probing depth (HPD) and vertical probing depth (VPD) were recorded at baseline, 3 months, 6 months and 9 months following the surgery. The bone area fill (BAF) was assessed using intraoral periapical radiographs (IOPARs) taken at baseline and 9 months after surgery. Results: At the baseline, there was no statistically significant difference between the tested parameters. After 9 months all the clinical parameters, PI, GI, PPD, CAL, HPD and VPD as well as radiographic bone fill showed a significant increase in both the groups (p < 0.05) (PI-TGr; CGr−VPD—3.5 ± 0.54 to 0.66 ± 0.51; 3.3 ± 0.81 to 2 ± 0.63/BAF—2.9 ± 0.88 to 5.6 ± 1.10; 3.4 ± 1.39 to 3.9 ± 1.4). On comparison the test group showed better results for each clinical parameter. Conclusion: The results showed increased improvement in clinical conditions in both groups, although better results were seen in the group where i-PRF with a nano-HA bone graft was used in the furcation defect.

Host Response Modulation Therapy in the Diabetes Mellitus—Periodontitis Conjuncture: A Narrative Review

The inflammatory response of the host in periodontitis is the phenomenon that underlies the onset and evolution of periodontal destructive phenomena. A number of systemic factors, such as diabetes mellitus (DM), can negatively affect the patient with periodontitis, just as the periodontal disease can aggravate the status of the DM patient. Host response modulation therapy involves the use of anti-inflammatory and anti-oxidant products aimed at resolving inflammation, stopping destructive processes, and promoting periodontal healing, all important aspects in patients with high tissue loss rates, such as diabetic patients. This paper reviews the data available in the literature on the relationship between DM and periodontitis, the main substances modulating the inflammatory response (nonsteroidal anti-inflammatory drugs, sub-antimicrobial doses of doxycycline, or omega-3 fatty acids and their products, specialized pro-resolving mediators), as well as their application in diabetic patients.

The Effects of 810 nm Diode Laser and Indocyanine Green on Periodontal Parameters and HbA1c in Patients with Periodontitis and Type II Diabetes Mellitus: A Randomized Controlled Study

The aim of this study was to investigate the effects of adjunctive periodontal therapy of 5 mg/mL indocyanine green irradiation by an 810 nm diode laser (aPDT), supplementary to scaling and root planing (SRP) in patients with periodontitis and type II diabetes mellitus (DM) compared to the SRP alone, on periodontal clinical parameters and glycated hemoglobin A1c (HbA1c). The study was conducted on 49 subjects with type II DM and periodontitis, divided into two groups: the SRP group (n = 25), who followed SRP alone, and the SRP + aPDT group (n = 24), who followed SRP and four weekly sessions of indocyanine green irradiation by an 810 nm diode laser. Plaque Index (PI), Bleeding on Probing Index (BOP), probing depth (PD), clinical attachment loss (CAL) and HbA1c were investigated at baseline and after 6 months. At 6 months, both SRP alone and SRP + aPDT generated significant reductions in all the investigated parameters; SRP + aPDT produced more significant reductions for BOP, PD and CAL (p < 0.001) but not for PI and HbA1c, than SRP alone. aPDT with indocyanine green therapy was well tolerated, with two subjects reporting slight discomfort. Therefore, aPDT with indocyanine green might represent a good adjunctive periodontal treatment option for SRP in patients with type II DM and periodontitis.

Potential Therapeutic Applications of Natural Compounds in Diabetes-Associated Periodontitis

Diabetes mellitus (DM) is a major worldwide health burden. DM is a metabolic disease characterized by chronic hyperglycemia, and if left untreated, can lead to various complications. Individuals with uncontrolled DM are more susceptible to periodontitis due to both a hyper-inflammatory host response and an impaired immune response. Periodontitis, on the other hand, may exacerbate DM by increasing both local and systemic inflammatory components of DM-related complications. The current standard for periodontal treatment in diabetes-associated periodontitis (DP) focuses mostly on reducing bacterial load and less on controlling the excessive host response, and hence, may not be able to resolve DP completely. Over the past decade, natural compounds have emerged as an adjunct approach for modulating the host immune response with the hope of curing DP. The anti-oxidant, anti-inflammatory, and anti-diabetic characteristics of natural substances are well-known, and they can be found in regularly consumed foods and drinks, as well as plants. The pathophysiology of DP and the treatment benefits of various bioactive extracts for DP will be covered in this review.

Antioxidant for treatment of diabetic complications: A meta-analysis and systematic review

Antioxidants may provide a complementary treatment for patients with chronic diseases. Nevertheless, studies that have measured the effects of antioxidant on diabetes complications have provided conflicting results. This study aimed to elucidate the association between antioxidant and diabetic complications and to develop robust evidence for clinical decisions by systematic reviews and meta-analysis. PubMed, Embase, The Cochrane Library, Web of Science, Scopus databases were searched to collect clinical studies related to the efficacy of antioxidants in the treatment of diabetes complications from inception to May 5, 2021. Statistical meta-analyses were performed using the RevMan 5.4 software. Stata16 software was used to detect publication bias. The data of diabetic nephropathy (DN), diabetic nonalcoholic fatty liver disease (NAFLD), and diabetic periodontitis were collected to analyze the effect of antioxidant on diabetes and the above three complications. The meta-analysis results showed that antioxidant treatment was associated with significantly changes in the fasting plasma glucose (FPG) (standardized mean difference [SMD]: - 0.21 [95% confidence interval [CI]: - 0.33, -0.10], p < 0.001), hemoglobin A1c (HbA1c) (MD: - 0.41 [95% CI: - 0.63, -0.18], p < 0.001), total antioxidant capacity (TAC) (SMD: 0.44 [95% CI: 0.24, 0.63], p < 0.001) and malondialdehyde (MDA) (SMD: - 0.82 [95% CI: - 1.24, -0.41], p < 0.001) than the control group. Antioxidant supplements have the potential to treat three complications of diabetes. In conclusion, the meta-analysis results indicate that antioxidant treatment is effective clinically for diabetes mellitus and its complications.

Curcumin as a Natural Approach of Periodontal Adjunctive Treatment and Its Immunological Implications: A Narrative Review

Scaling and root planing represent the gold standard in the treatment of periodontal disease, but these therapeutic methods cannot eliminate the remaining periodontopathogenic bacteria in cement, tubules, and periodontal soft tissue. Thus, a number of additional therapeutic means have been adopted, including local and systemic antibiotic therapy, as well as the use of photodynamic therapy techniques. Recently, special attention has been paid to potential phytotherapeutic means in the treatment of periodontal disease. In this review, we aim to present the effects generated by the extract of Curcuma longa, the various forms of application of turmeric as an additional therapeutic means, as well as the aspects related to its biotolerance.

Curcumin as a Natural Approach of Periodontal Adjunctive Treatment and Its Immunological Implications: A Narrative Review

Scaling and root planing represent the gold standard in the treatment of periodontal disease, but these therapeutic methods cannot eliminate the remaining periodontopathogenic bacteria in cement, tubules, and periodontal soft tissue. Thus, a number of additional therapeutic means have been adopted, including local and systemic antibiotic therapy, as well as the use of photodynamic therapy techniques. Recently, special attention has been paid to potential phytotherapeutic means in the treatment of periodontal disease. In this review, we aim to present the effects generated by the extract of Curcuma longa, the various forms of application of turmeric as an additional therapeutic means, as well as the aspects related to its biotolerance.

Efficacy of Antioxidant Supplementation to Non-Surgical Periodontal Therapy on Metabolic Control in Type 2 Diabetes Patients: A Network Meta-Analysis

This network meta-analysis (NMA) investigated the effectiveness of antioxidants as adjuncts to non-surgical periodontal therapy (NSPT) in the glycated hemoglobin (HbA1c) control of type 2 diabetes (T2D) patients with periodontitis. PubMed, Cochrane, LILACS, Web of Science, Scopus, Embase, LIVIVO, and grey literature were searched. Risk of bias was assessed with the RoB v2.0 tool. A frequentist NMA assessed HbA1c improvement, through standardized mean difference under a random-effects model. Certainty of evidence was addressed through the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) partially contextualized framework. Ten randomized controlled clinical trials were included, with 234 patients receiving alpha lipoic acid (ALA), cranberry juice, cranberry juice enriched with omega-3, fenugreek, ginger, grape seed, lycopene, melatonin, omega-3, propolis or vitamin C supplementation to NSPT, and 220 patients receiving NSPT alone or with placebo. Nine studies were meta-analyzed. HbA1c improved when NSPT was combined with propolis, ALA and melatonin supplementation (moderate-to-low certainty), compared to NSPT alone or with placebo. Risk of bias issues were found in eight studies. In conclusion, the use of propolis supplementation to NSPT probably results in HbA1c improvement in T2D patients with periodontitis (large effect with moderate certainty), while ALA and melatonin supplementation may contribute to reduce the HbA1c in T2D patients with periodontitis (large effects with low certainty).

Clinical efficacy of melatonin as adjunctive therapy to non-surgical treatment of periodontitis: a systematic review and meta-analysis

OBJECTIVE

This study aimed to evaluate the effect of adjunctive melatonin supplementation on clinical outcomes after non-surgical periodontal treatment.

METHODS

PubMed, Embase, and Web of Science databases were systematically searched for randomised controlled trials (RCTs) of melatonin adjuvant therapy for periodontitis from inception until May 2021. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered on The International Prospective Register of Systematic Reviews (PROSPERO) (CRD42021250630). The risk of bias of included studies was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. The pooled effect estimates were calculated by a random-effects model, and results were expressed as weighted mean differences (WMD).

RESULTS

Seven RCTs comprising 412 participants were included in the meta-analysis. The pooled results showed that adjuvant use of melatonin for non-surgical periodontal treatment significantly improved the probing depth (PD) [WMD = - 1.18, 95% CI (- 1.75, - 0.62) I² = 85.7%], clinical attachment loss (CAL) [WMD = - 1.16, 95% CI (- 1.60, - 0.72) I² = 76.7%] and gingival index (WMD = - 0.29, 95%CI [- 0.48, - 0.11], I² = 63.6%) compared with non-surgical treatment alone. In addition, subgroup analysis showed that higher doses of melatonin (3-10 mg) significantly improved PD [WMD = - 1.32, 95%CI (- 2.31, - 0.15) I² = 93%] and CAL [WMD = - 1.30, 95%CI (- 1.80, - 0.81) I² = 73.7%] compared with lower doses of melatonin (< 3 mg).

CONCLUSIONS

We found that adjunctive melatonin supplementation can significantly improve the periodontal status after non-surgical treatment, suggesting that melatonin may be a new adjuvant therapy for periodontitis when non-surgical periodontal treatment alone cannot achieve the desired improvement.

Clinical Effects of Locally Delivered Lactobacillus reuteri as Adjunctive Therapy in Patients with Periodontitis: A Split-Mouth Study

Different methods and products have been investigated as measures of adjunctive therapy to scaling and root planing (SRP). Probiotic use has gained interest for this particular application, especially Lactobacillus spp. This split-mouth interventional prospective study aimed to evaluate the clinical effects of L. reuteri DSM 17938 with local application in periodontal pockets of severe periodontitis patients. The study was conducted on 40 subjects with stage 3–4 periodontitis who, based on a split-mouth model, followed SRP and SRP + L. reuteri solution in five weekly sessions. Probing depth (PD), clinical attachment loss (CAL), and bleeding on probing (BOP) were assessed at baseline and at three months after probiotic treatment completion. Both SRP and SRP + L. reuteri generated significant improvements of all three clinical parameters, but the changes were significantly better for SRP + L. reuteri treated sites. Therefore, we can conclude that adjunctive therapy with L. reuteri DSM 17938 could represent an interesting treatment option, particularly for severe periodontitis cases.

Paraprobiotics in Non-Surgical Periodontal Therapy: Clinical and Microbiological Aspects in a 6-Month Follow-Up Domiciliary Protocol for Oral Hygiene

Periodontal disease represents a progressive destruction of tooth-supporting tissues. Recently, paraprobiotics are regarded as an adjunctive therapy to the non-surgical Scaling-and-Root-Planing (SRP). The aim of this study is to evaluate the efficacy of two new formulations of paraprobiotics, a toothpaste and a mouthwash, respectively, for the domiciliary hygiene. A total of 40 patients were randomly assigned to the following domiciliary treatments: Group 1 (SRP + Curasept Intensive Treatment 0.2% chlorhexidine) (control) and Group 2 (SRP + Biorepair Peribioma toothpaste + Biorepair Peribioma Mousse mouthwash) (trial). At baseline (T0) and after 3 and 6 months (T1-T2), periodontal clinical (Bleeding on Probing, Probing Pocket Depth, Clinical Attachment Loss, Bleeding Score, Sulcus Bleeding Index, Plaque Index, Approximal Plaque Index, Adherent Gingiva, Gingival Recession, and Pathological Sites) and microbiological parameters (Pathological Bacteria, Saprophytic Bacteria, Enlarged Red Complex, Red Complex, Orange Complex, and counts of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythensys, Treponema denticola, Prevotella intermedia, and Fusobacterium nucleatum). The use of the experimental products resulted in a significant reduction of most of the clinical indices assessed, which occurred at a major degree with respect to the conventional chlorhexidine considered as control. Additionally, after 6 months of use, the abovementioned products significantly decreased the percentage of pathological bacteria and the counts of those bacteria constituting the "Red Complex", more related to the periodontal disease. Accordingly, the paraprobiotics-based products tested in this study seem to represent a valid support to SRP with a benefit on both clinical indices and on specific periodontopathogens.

Correlations between Salivary Immuno-Biochemical Markers and HbA1c in Type 2 Diabetes Subjects before and after Dental Extraction

Dental extraction can trigger certain sequences of complex processes that involve both hard (alveolar bone) and soft tissue (periodontal ligament, gingiva) remodeling. Type 2 diabetes is a serious risk factor for many oral pathologies, both in terms of progression and severity, but also regarding subsequent rehabilitation possibilities. The aim of this study was to establish whether certain molecules: osteoprotegerin (OPG), kappa B nuclear factor receptor activator ligand (RANKL), hepatocyte growth factor (HGF), tumor necrosis factor-α (TNF-α), interleukin 18 (IL-18), matrix metalloproteinase 9 (MMP-9) and oxidative stress markers-total oxidant status (TOS), total antioxidant capacity (TAC)-evaluated in saliva are modified post-extraction in type 2 diabetes mellitus subjects and whether there is a correlation with HbA1c levels. The aforementioned markers plus HbA1c were investigated in a group of systemically healthy subjects (n = 45) and in a type 2 diabetes mellitus group (n = 41) before and three months after a tooth extraction. Diabetes patients' recorded increased levels of OPG, RANKL, TNF-α, MMP-9, IL-18 and TOS compared to controls both pre- and post-extraction. In both study groups, the average OPG, HGF and TAC level recorded an upward trend three months post-extraction. TNF-α registered a statistically significant decrease only in the diabetes group after dental extraction, together with a decrement of mean HbA1c levels in the diabetes group. By plotting the ROC (receiver operating characteristic) curve, at baseline RANKL, TNF-α, IL-18, MMP-9, TOS and OPG were good predictors of HbA1c levels. Post-extraction, there was a significant correlation between HbA1c and oxidative status biomarkers, however the linear regression model indicated the influence of all studied salivary markers in HbA1c determinism, in a considerable proportion. In conclusion, our study demonstrated that several oxidative status markers and proinflammatory biomarkers are modified in the saliva of diabetic patients and they correlate to HbA1c levels, thus being potential indicators of the post-extraction healing status in the oral cavity.

Effects of Antioxidant in Adjunct with Periodontal Therapy in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis

This review investigated whether the adjunctive use of antioxidants with periodontal therapy improves periodontal parameters in patients with type 2 diabetes. A systematic and extensive literature search for randomized controlled trials (RCTs) conducted before April 2021 was performed on the PubMed, Cochrane Library, and Web of Science databases. The risk of bias was assessed using the Cochrane risk-of-bias tool. A meta-analysis was performed to quantitatively evaluate the clinical outcomes following periodontal therapy. After independent screening of 137 initial records, nine records from eight RCTs were included. The risk-of-bias assessment revealed that all RCTs had methodological weaknesses regarding selective bias, although other risk factors for bias were not evident. This meta-analysis of two RCTs showed that periodontal pocket depths were significantly reduced in the groups treated with combined non-surgical periodontal therapy and melatonin than in those treated with non-surgical periodontal therapy alone. The present systematic review and meta-analysis suggest that the adjunctive use of melatonin, resveratrol, omega-3 fatty acids with cranberry juice, propolis, and aloe vera gel with periodontal therapy significantly improves periodontal disease parameters in patients with type 2 diabetes, and melatonin application combined with non-surgical periodontal therapy might significantly reduce periodontal pocket depth. However, there are still limited studies of melatonin in combination with non-surgical periodontal therapy in Type 2 diabetic patients, and more well-designed RCTs are required to be further investigated.

Melatonin as an adjunctive treatment on dental procedures: A systematic review

The systematic review tried to answer the following question: Does the melatonin administered systemically or topically ameliorate patients involved with oral health conditions or dental procedures? The systematic review has been registered in the PROSPERO (2021CRD42021095959). Eligibility criteria included only randomized controlled clinical trials (RCTs) with at least 10 participants that compared patients that received melatonin as a treatment before and/or after their oral intervention topically or systemically, with control patients. A search was performed in PubMed/MEDLINE, Web of Science, Cochrane Library, and Academic Google databases for articles up to February 2021. The Cochrane risk-of-bias tool for randomized clinical trials was used and revealed that the studies included presented low risk of bias for the majority of criteria assessed. It was selected 25 articles, of which only six did not demonstrate positive effects and three presented null effects with the use of melatonin. Melatonin has improved the inflammatory response in periodontal disease, dental surgeries, and mucositis of head and neck oncologic irradiated patients. In addition, it showed anxiolytic potential in patients that were submitted to dental procedures. In conclusion, melatonin favored the treatment of oral changes when used topically and systemically.