Metformin gel in the treatment of generalized aggressive periodontitis
Authors: Nour Sohair M. , Elguindy Hoda M. , Morad Morad A. 
Published: May 2023

Objectives
The aim of this study was to assess the adjunctive regenerative effect of metformin (MF) gel in the treatment of stage II grade C periodontitis utilizing β-TCP bone graft in the control group, and β-TCP bone graft mixed with 1% MF gel in the test group on clinical, radiographic, and biochemical parameters.

Patients and methods
Thirty intrabony defects were selected in seven patients who met the inclusion criteria. Patients were randomly distributed in the two study groups and treated with β-TCP bone graft plus collagen membrane in the control group and β-TCP bone graft mixed with 1% MF gel plus collagen membrane in the test group. Clinically, evaluation was carried out by clinical parameters (bleeding on probing, pocket depth, and clinical attachment loss) at 3, 6, and 9 months posttreatment. Biochemically, gingival crevicular fluid concentration of receptor activator of nuclear factor-κB ligand (RANKL) and Osteoprotegerin (OPG) at baseline and 9 months posttreatment were evaluated and RANKL/OPG ratio was calculated. Radiographically, quantitative digital subtraction radiography was used to evaluate bone gain and bone mineral density at 9 months posttreatment follow up period.

Results
The intragroup comparison in the two studied groups demonstrated statistically significant improvement in all clinical parameters (bleeding on probing, pocket depth, and clinical attachment loss) after 3, 6, and 9 months when they were compared to their corresponding values at baseline, while, the intergroup comparison showed that there is no statistically significant difference regarding all clinical parameters at 3, 6, and 9 months posttreatment except pocket depth which differs statistically significant at 3 months posttreatment. The intragroup comparison of RANKL and OPG was statistically significant between baseline and 9 months posttreatment in the two groups but intergroup comparison revealed that there is no statistically significant difference. Regarding RANKL/OPG ratio, the intragroup analysis revealed that there was a statistically significant change in this ratio from baseline to 9 months posttreatment in the test and control group. Additionally, the intergroup analysis revealed that there was no statistically significant difference in RANKL/OPG ratio between the test and control group at baseline and at 9 month posttreatment. The intragroup quantitative digital subtraction radiography analysis demonstrated statistically significant bone gain and increase in bone mineral density in the two studied groups. Also, the intergroup comparison revealed that no statistically significant increase in bone level in the two groups although increase in bone density was statistically significant.

Conclusion
The present study demonstrated that guided tissue regeneration utilizing 1% MF gel combined with β-TCP bone graft showed better radiographic results, when compared with guided tissue regeneration utilizing β-TCP bone graft alone. The adjunctive regenerative action of MF is promising material for periodontal regeneration.