DOI QR코드

DOI QR Code

Effectiveness of alendronate as an adjunct to scaling and root planing in the treatment of periodontitis: a meta-analysis of randomized controlled clinical trials

  • Chen, Jin (Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing Medical University College of Stomatology) ;
  • Chen, Qian (Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing Medical University College of Stomatology) ;
  • Hu, Bo (Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing Medical University College of Stomatology) ;
  • Wang, Yunji (Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing Medical University College of Stomatology) ;
  • Song, Jinlin (Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing Medical University College of Stomatology)
  • Received : 2016.08.22
  • Accepted : 2016.11.01
  • Published : 2016.12.31

Abstract

Purpose: Alendronate has been proposed as a local and systemic drug treatment used as an adjunct to scaling and root planing (SRP) for the treatment of periodontitis. However, its effectiveness has yet to be conclusively established. The purpose of the present meta-analysis was to assess the effectiveness of SRP with alendronate on periodontitis compared to SRP alone. Methods: Five electronic databases were used by 2 independent reviewers to identify relevant articles from the earliest records up to September 2016. Randomized controlled trials (RCTs) comparing SRP with alendronate to SRP with placebo in the treatment of periodontitis were included. The outcome measures were changes in bone defect fill, probing depth (PD), and clinical attachment level (CAL) from baseline to 6 months. A fixed-effect or random-effect model was used to pool the extracted data, as appropriate. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed using the Cochrane ${\chi}^2$ and $I^2$ tests. Results: After the selection process, 8 articles were included in the meta-analysis. Compared with SRP alone, the adjunctive mean benefits of locally delivered alendronate were 38.25% for bone defect fill increase (95% CI=33.05%-43.45%; P<0.001; $I^2=94.0%$), 2.29 mm for PD reduction (95% CI=2.07-2.52 mm; P<0.001; $I^2=0.0%$) and 1.92 mm for CAL gain (95% CI=1.55-2.30 mm; P<0.001; $I^2=66.0%$). In addition, systemically administered alendronate with SRP significantly reduced PD by 0.36 mm (95% CI=0.18-0.55 mm; P<0.001; $I^2=0.0%$) and increased CAL by 0.39 mm (95% CI=0.11-0.68 mm; P=0.006; $I^2=6.0%$). Conclusions: The collective evidence regarding the adjunctive use of alendronate locally and systemically with SRP indicates that the combined treatment can improve the efficacy of non-surgical periodontal therapy on increasing CAL and bone defect fill and reducing PD. However, precautions must be exercised in interpreting these results, and multicenter studies evaluating this specific application should be carried out.

Keywords

References

  1. Periodontal diseases: pathogenesis and microbial factors. J Am Dent Assoc 1998;129 Suppl:58S-62S. https://doi.org/10.1016/S0002-8177(15)30088-X
  2. Armitage GC, Robertson PB. The biology, prevention, diagnosis and treatment of periodontal diseases: scientific advances in the United States. J Am Dent Assoc 2009;140 Suppl 1:36S-43S. https://doi.org/10.14219/jada.archive.2009.0356
  3. Lindhe J, Nyman S. The effect of plaque control and surgical pocket elimination on the establishment and maintenance of periodontal health. A longitudinal study of periodontal therapy in cases of advanced disease. J Clin Periodontol 1975;2:67-79. https://doi.org/10.1111/j.1600-051X.1975.tb01727.x
  4. Hill RW, Ramfjord SP, Morrison EC, Appleberry EA, Caffesse RG, Kerry GJ, et al. Four types of periodontal treatment compared over two years. J Periodontol 1981;52:655-62. https://doi.org/10.1902/jop.1981.52.11.655
  5. Ramfjord SP, Caffesse RG, Morrison EC, Hill RW, Kerry GJ, Appleberry EA, et al. Four modalities of periodontal treatment compared over five years. J Periodontal Res 1987;22:222-3. https://doi.org/10.1111/j.1600-0765.1987.tb01573.x
  6. Salvi GE, Lang NP. Host response modulation in the management of periodontal diseases. J Clin Periodontol 2005;32 Suppl 6:108-29. https://doi.org/10.1111/j.1600-051X.2005.00785.x
  7. Offenbacher S. Periodontal diseases: pathogenesis. Ann Periodontol 1996;1:821-78. https://doi.org/10.1902/annals.1996.1.1.821
  8. Graves D. Cytokines that promote periodontal tissue destruction. J Periodontol 2008;79:1585-91. https://doi.org/10.1902/jop.2008.080183
  9. Ciancio SG. Systemic medications: clinical significance in periodontics. J Clin Periodontol 2002;29 Suppl 2:17-21. https://doi.org/10.1034/j.1600-051X.29.s2.5.x
  10. Reszka AA, Rodan GA. Bisphosphonate mechanism of action. Curr Rheumatol Rep 2003;5:65-74. https://doi.org/10.1007/s11926-003-0085-6
  11. Rogers MJ, Gordon S, Benford HL, Coxon FP, Luckman SP, Monkkonen J, et al. Cellular and molecular mechanisms of action of bisphosphonates. Cancer 2000;88:2961-78. https://doi.org/10.1002/1097-0142(20000615)88:12+<2961::AID-CNCR12>3.0.CO;2-L
  12. Binderman I, Adut M, Yaffe A. Effectiveness of local delivery of alendronate in reducing alveolar bone loss following periodontal surgery in rats. J Periodontol 2000;71:1236-40. https://doi.org/10.1902/jop.2000.71.8.1236
  13. Tenenbaum HC, Shelemay A, Girard B, Zohar R, Fritz PC. Bisphosphonates and periodontics: potential applications for regulation of bone mass in the periodontium and other therapeutic/diagnostic uses. J Periodontol 2002;73:813-22. https://doi.org/10.1902/jop.2002.73.7.813
  14. Weinreb M, Quartuccio H, Seedor JG, Aufdemorte TB, Brunsvold M, Chaves E, et al. Histomorphometrical analysis of the effects of the bisphosphonate alendronate on bone loss caused by experimental periodontitis in monkeys. J Periodontal Res 1994;29:35-40. https://doi.org/10.1111/j.1600-0765.1994.tb01088.x
  15. Hu JH, Ding M, Soballe K, Bechtold JE, Danielsen CC, Day JS, et al. Effects of short-term alendronate treatment on the three-dimensional microstructural, physical, and mechanical properties of dog trabecular bone. Bone 2002;31:591-7. https://doi.org/10.1016/S8756-3282(02)00870-0
  16. Veena HR, Prasad D. Evaluation of an aminobisphosphonate (alendronate) in the management of periodontal osseous defects. J Indian Soc Periodontol 2010;14:40-5. https://doi.org/10.4103/0972-124X.65438
  17. Kruszewska H, Zareba T, Tyski S. Search of antimicrobial activity of selected non-antibiotic drugs. Acta Pol Pharm 2002;59:436-9.
  18. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009;62:e1-34. https://doi.org/10.1016/j.jclinepi.2009.06.006
  19. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009;62:1006-12. https://doi.org/10.1016/j.jclinepi.2009.06.005
  20. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. Oxford: The Cochrane Collaboration; 2011.
  21. Pradeep AR, Kumari M, Rao NS, Naik SB. 1% alendronate gel as local drug delivery in the treatment of Class II furcation defects: a randomized controlled clinical trial. J Periodontol 2013;84:307-15. https://doi.org/10.1902/jop.2012.110729
  22. Sharma A, Pradeep AR. Clinical efficacy of 1% alendronate gel as a local drug delivery system in the treatment of chronic periodontitis: a randomized, controlled clinical trial. J Periodontol 2012;83:11-8. https://doi.org/10.1902/jop.2011.110091
  23. Sharma A, Pradeep AR. Clinical efficacy of 1% alendronate gel in adjunct to mechanotherapy in the treatment of aggressive periodontitis: a randomized controlled clinical trial. J Periodontol 2012;83:19-26. https://doi.org/10.1902/jop.2011.110206
  24. Pradeep AR, Sharma A, Rao NS, Bajaj P, Naik SB, Kumari M. Local drug delivery of alendronate gel for the treatment of patients with chronic periodontitis with diabetes mellitus: a double-masked controlled clinical trial. J Periodontol 2012;83:1322-8. https://doi.org/10.1902/jop.2012.110292
  25. Pradeep AR, Kanoriya D, Singhal S, Garg V, Manohar B, Chatterjee A. Comparative evaluation of subgingivally delivered 1% alendronate versus 1.2% atorvastatin gel in treatment of chronic periodontitis: a randomized placebo-controlled clinical trial. J Investig Clin Dent. Forthcoming 2016.
  26. Lane N, Armitage GC, Loomer P, Hsieh S, Majumdar S, Wang HY, et al. Bisphosphonate therapy improves the outcome of conventional periodontal treatment: results of a 12-month, randomized, placebo-controlled study. J Periodontol 2005;76:1113-22. https://doi.org/10.1902/jop.2005.76.7.1113
  27. Rocha M, Nava LE, Vazquez de la Torre C, Sanchez-Marin F, Garay-Sevilla ME, Malacara JM. Clinical and radiological improvement of periodontal disease in patients with type 2 diabetes mellitus treated with alendronate: a randomized, placebo-controlled trial. J Periodontol 2001;72:204-9. https://doi.org/10.1902/jop.2001.72.2.204
  28. Rocha ML, Malacara JM, Sanchez-Marin FJ, Vazquez de la Torre CJ, Fajardo ME. Effect of alendronate on periodontal disease in postmenopausal women: a randomized placebo-controlled trial. J Periodontol 2004;75:1579-85. https://doi.org/10.1902/jop.2004.75.12.1579
  29. Durie BG, Katz M, Crowley J. Osteonecrosis of the jaw and bisphosphonates. N Engl J Med 2005;353:99-102. https://doi.org/10.1056/NEJM200507073530120
  30. De Almeida J, Ervolino E, Bonfietti LH, Novaes VC, Theodoro LH, Fernandes LA, et al. Adjuvant therapy with sodium alendronate for the treatment of experimental periodontitis in rats. J Periodontol 2015;86:1166-75. https://doi.org/10.1902/jop.2015.150166
  31. Menezes AM, Rocha FA, Chaves HV, Carvalho CB, Ribeiro RA, Brito GA. Effect of sodium alendronate on alveolar bone resorption in experimental periodontitis in rats. J Periodontol 2005;76:1901-9. https://doi.org/10.1902/jop.2005.76.11.1901

Cited by

  1. The effect of statins on periodontal treatment-a systematic review with meta-analyses and meta-regression vol.22, pp.2, 2016, https://doi.org/10.1007/s00784-018-2354-9
  2. Synergistic Application of Platelet-Rich Fibrin and 1% Alendronate in Periodontal Bone Regeneration: A Meta-Analysis vol.2019, pp.None, 2019, https://doi.org/10.1155/2019/9148183
  3. Medications for Chronic Conditions and Periodontal Disease vol.6, pp.1, 2016, https://doi.org/10.1007/s40496-019-0205-7
  4. EFFECT OF LOCALLY DELIVERED BISPHOSPHONATES ON ALVEOLAR BONE: A SYSTEMATIC REVIEW AND META-ANALYSIS vol.21, pp.3, 2016, https://doi.org/10.1016/j.jebdp.2021.101580