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

Abstract

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.

Adjunctive subgingival application of Chlorhexidine gel in nonsurgical periodontal treatment for chronic periodontitis: a systematic review and meta-analysis

“…In regards to this issue, adjunctive systemic and localized antibiotics have been applied to compensate for the limitation of mechanical therapy. Despite the rapid development of a variety of adjunctive local periodontal treatments in recent years, such as metformin, antioxidants, photodynamic treatment and so on [7][8][9], chlorhexidine (CHX) remains one of the most effective local antimicrobial agents, and is widely used for the local treatment of periodontitis [10][11][12][13]. Through the rapid attraction of the negatively charged bacterial cell surface to the cationic CHX molecule, CHX shows strong antibacterial activity in the periodontal pocket, along with a lack of toxicity, incompliance from patients and an emergence of resistance microorganisms.…”

Effect of local probiotic (Lactobacillus reuteri) vs systemic antibiotic therapy as an adjunct to non‐surgical periodontal treatment in chronic periodontitis

“…Considering the limitations of SRP, many commercially‐available adjunctives can be helpful in overcoming these shortcomings. Local and systemic antibiotics, photodynamic therapy, locally‐delivered statins, and metformin are some of the suggested adjunctives, among which the most widely used are systemic antibiotics. However, restoring symbiotic bacteria causes a change in the local environment, which could enable SRP to resolve inflammation and prevent further recolonization .…”

Effect of metformin on human periodontal ligament stem cells cultured with polydopamine‐templated hydroxyapatite

“…Besides the protective effect, metformin is confirmed to enhance osteogenic differentiation and mineralization in vitro and increase bone density in vivo . Moreover, it is used in adjunct to scaling and root planing in the treatment of periodontal defects, showing significant repair .…”