Chronic Periodontitis
Conditions
Keywords
Periodontal Disease, Chronic Periodontitis, Atorvastatin, Statins, Hydroxymethylglutaryl-coenzyme A Reductase Inhibitors, Dentifrice
Brief summary
Periodontal disease (PD) is an inflammatory, infectious and destructive condition of the tissues surrounding the teeth. However, even if bacteria are required to initiate periodontal disease, the immune response is responsible for most of the destruction of the periodontal tissues. Statins may be used to control the immune response to periodontal pathogens, a factor that has not yet been managed clinically and even less massively. Recently it has been reported the pharmacological effectiveness of topically used statins. For periodontal disease, at least four well conducted clinical trials have been published using a topically statin formula for pocket irrigation in adult populations with chronic periodontal disease, observing surprising clinical results in all of them (with clinical and statistical significance) and no adverse reactions. The purpose of the present study is asses the effectiveness of a medicated 2% atorvastatin dentifrice, as complement to non-surgical conventional periodontal treatment. Clinical examination will be made at the beginning and after one month of treatment.
Detailed description
An medicated 2% atorvastatin dentifrice (2 mg x every 0.1 ml of dentifrice) will be prepared for dental brushing. It will be used as a base a fluoride dentifrice, to which will be added atorvastatin in the prescribed amount. Medicated prototypes and placebos will be dosed in 5 ml syringes indicating each 0.5 ml measures to facilitate dispensing the product and ensure proper use. Thus, each syringe will be for 10 doses of toothpaste (10 brushings). 6 syringes will be provided to each patient, so that they have enough for a month of treatment, during which they will have to brush 2 times a day. Sample size: A clinical trial with two parallel groups (1:1) will be conducted, where there will be 2 groups of 19 patients each. The estimated sample size was based on the difference in attachment level achieved in the study Goodson et al (Goodson, Haffajee, Socransky, Kent, Teles, Hasturk, Bogren, Van Dyke, Wennstrom, Lindhe. Control of periodontal infections: A randomized controlled trial I. The primary outcome attachment gain and pocket depth reduction at Treated sites. J Clin Periodontol 2012, 39: 526-536), with a power of 90%, a significance level of 0.05 two-tailed. Treatments and protocols: Patients will be treated at the Department of Periodontology of Health Care Center, Universidad de Los Andes in San Bernardo, Santiago, Chile. The two groups will undergo non-surgical periodontal therapy consisting of scaling and root planning of all tooth groups. Therapy will be supplemented with oral hygiene instruction, indicating patients to brush with the dentifrice that will be provided, 2 times a day for two minutes each time. Then they will be told to spit the dentifrice excesses during 30 seconds, but not to rinse their teeth, or consume liquids or solid foods for at least 30 minutes. A group of 19 patients will receive the medicated 2%atorvastatin dentifrice while the other group of 19 patients will receive dentifrice without the drug to act as a placebo. The record of the application of statins will be done by a professor at the Faculty of Dentistry, before periodontal clinical evaluation, in order not to influence the researcher. The allocation to each group will be random and there will be a sequence concealment. Analysis Plan: Continuous variables will be described by measures of central tendency and dispersion. Dichotomous variables will be tabulated and described by absolute frequencies and percentages according to each group. The delta of the outcome variables will be calculated as the difference between measurements before and after intervention. Multiple linear regression models will be used to compare the deltas of outcome variables after adjusting for gender, diabetes and tobacco use. A p value of \<0.05 is considered statistically significant. The analysis will be performed with Stata software (version 12; Stata Corporation, Lakeway Drive, College Station, Texas, USA).
Interventions
DRUGMedicated 2% atorvastatin dentifrice
Non surgical periodontal therapy accompanied by medicated 2% atorvastatin dentifrice (20 mg per ml) 2 times a day for two minutes each time, for 30
DRUGNon-medicated dentifrice
Non surgical periodontal therapy accompanied by non medicated dentifrice 2 times a day for two minutes each time, for 30 days.
Sponsors
Corporación de Fomento de la Producción, Chile
Universidad de los Andes, Chile
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
35 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients included in the study will be those fully agreeing to participate by signing an informed consent, which has been submitted to and approved, together with the study protocol by the Ethics Committee of the Faculty of Dentistry of Universidad de Los Andes. * The target population consists of 38 adult patients who consult the Service of Periodontology at the Universidad de Los Andes. * The eligible population are those that meet the following criteria: 1. more than 35 years of age. 2. with at least 14 natural teeth in mouth (excluding third molars). 3. have some degree of periodontal disease.
Exclusion criteria
* Will be excluded those who: 1. Relate migration plans. 2. Presence of limiting disease for the understanding and execution of the study or are hospitalized. 3. Received periodontal treatment in the last year. 4. Completed antibiotic therapy or Non Steroidal Anti-inflammatory Drugs (NSAIDs) in the last two weeks. 5. Are using calcium channel blockers, phenytoin, cyclosporine or any associated drug that may affect gingival tissue. 6. Have autoimmune pathology. 7. Require antibiotic prophylaxis for periodontal treatment. 8. Patients requiring treatment with NSAIDs for postoperative pain control after the procedure done. 9. Patients on statin therapy for dyslipidemia. 10. Pregnant patients.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Periodontal Inflammation Surface Area (PISA) | baseline and 1 month later of intervention | PISA will be computed through an Excel spreadsheet, using data of clinical attachment level, gingival recession and bleeding on probing. Change in PISA: baseline measure minus 1 month later measure. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Mean Pocket Depth (PD) | baseline and 1 month later | The PD will be defined as the distance from the free gingival margin to the bottom of the pocket. For each tooth will be conducted periodontal probing at 6 sites (mesiobuccal, mediobuccal, distobuccal, mesiolingual / palatal, mediolingual / palatal, distolingual/ palatal). Change in mean PD: baseline measure minus 1 month later measure. |
| Change in Clinical Attachment Level (CAL) | baseline and 1 month after intervention | The Clinical Attachment Level (CAL) is defined as the distance from the cement-enamel junction to the fornix of the pocket. For each tooth will be performed periodontal probing at 6 sites (mesiobuccal, mediobuccal, distobuccal mesiolingual / palatal mediolingual / distolingual palatal / lingual). Change in CAL: baseline measure minus 1 month later measure. |
| Change in Bleeding on Probing Index (BOP) | baseline and 1 month after intervention | The bleeding on probing index (BOP) will be determined by assigning + to the presence of bleeding on vestibular / palatine probing of the tooth examined and with a sign - the abscence. Later the + signs will be summed and divided by the number of sites examined. Change in BOP: baseline measure minus 1 month later measure. |
| Change in Gingival Index | baseline and 1 month after intervention | Determined as score assigned to each site evaluated respect to clinical criteria as followed: Score Criteria: 0\. No inflammation 1. Mild inflammation, slight change in color, slight edema, no bleeding on probing. 2. Moderate inflammation, moderate glazing, redness, bleeding on probing. 3. Severe inflammation, marked redness and hypertrophy, ulceration, tendency to spontaneous bleeding. Then was calculated a score for each sextant summed the score and divided by the number of examined sites. Later was summed each sextant score and divided by sextant evaluated. The change was calculated as baseline measure minus 1 month later measure. |
Countries
Chile
Participant flow
Recruitment details
The investigation was conducted at the Department of Periodontology of Universidad de Los Andes. Patients were enrolled in the study between June 2013 and August 2013, derived from the Health Care Center, Universidad de los Andes (San Bernardo, Santiago, Chile).
Participants by arm
| Arm | Count |
|---|---|
| Atorvastatin Group A group of 19 patients received non surgical periodontal therapy accompanied by instruction for oral hygiene, using a medicated 2% atorvastatin dentifrice 2 times a day for two minutes each time for a period of 30 days. | 18 |
| Placebo Group A group of 19 patients received non surgical periodontal therapy accompanied by instruction for oral hygiene, using a non-medicated dentifrice as placebo 2 times a day for two minutes each time, for 30 days. | 18 |
| Total | 36 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 1 | 1 |
Baseline characteristics
| Characteristic | Placebo Group | Total | Atorvastatin Group |
|---|---|---|---|
| Age, Continuous | 45.72 years STANDARD_DEVIATION 9.08 | 45.56 years STANDARD_DEVIATION 8.95 | 45.39 years STANDARD_DEVIATION 9.07 |
| Bleeding on probing | 53.47 Percentage of probed sites with BOP STANDARD_DEVIATION 17.77 | 65.67 Percentage of probed sites with BOP STANDARD_DEVIATION 21.59 | 77.86 Percentage of probed sites with BOP STANDARD_DEVIATION 18.12 |
| Clinical attachment level | 2.52 millimeters STANDARD_DEVIATION 0.9 | 3.12 millimeters STANDARD_DEVIATION 1.38 | 3.73 millimeters STANDARD_DEVIATION 1.52 |
| Diabetic diabetic patients | 1 participants | 4 participants | 3 participants |
| Diabetic non-diabetic patients | 17 participants | 32 participants | 15 participants |
| Gingival index | 1.54 score on a scale STANDARD_DEVIATION 0.21 | 1.74 score on a scale STANDARD_DEVIATION 0.33 | 1.95 score on a scale STANDARD_DEVIATION 0.31 |
| Oral hygienic index | 12.88 percent of surface without plaque STANDARD_DEVIATION 18.01 | 10.10 percent of surface without plaque STANDARD_DEVIATION 17.42 | 7.32 percent of surface without plaque STANDARD_DEVIATION 16.85 |
| Periodontal inflamed surface area (PISA) | 814.82 square millimeters STANDARD_DEVIATION 488.54 | 954 square millimeters STANDARD_DEVIATION 477.67 | 1093.18 square millimeters STANDARD_DEVIATION 435.96 |
| Probing depth | 2.80 millimeters STANDARD_DEVIATION 0.86 | 3.27 millimeters STANDARD_DEVIATION 0.98 | 3.74 millimeters STANDARD_DEVIATION 0.87 |
| Recession | 0.28 millimeters STANDARD_DEVIATION 0.94 | 0.14 millimeters STANDARD_DEVIATION 1.04 | 0.01 millimeters STANDARD_DEVIATION 1.14 |
| Sex: Female, Male Female | 11 Participants | 25 Participants | 14 Participants |
| Sex: Female, Male Male | 7 Participants | 11 Participants | 4 Participants |
| Smokers non-smokers patients | 7 participants | 20 participants | 13 participants |
| Smokers smokers patients | 11 participants | 16 participants | 5 participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 19 | 0 / 19 |
| serious Total, serious adverse events | 0 / 19 | 0 / 19 |
Outcome results
Primary
Change in Periodontal Inflammation Surface Area (PISA)
PISA will be computed through an Excel spreadsheet, using data of clinical attachment level, gingival recession and bleeding on probing. Change in PISA: baseline measure minus 1 month later measure.
Time frame: baseline and 1 month later of intervention
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Atorvastatin Toothpaste | Change in Periodontal Inflammation Surface Area (PISA) | 638.16 square millimeters | Standard Deviation 398.74 |
| Non Medicated Gel Toothpaste | Change in Periodontal Inflammation Surface Area (PISA) | 288.72 square millimeters | Standard Deviation 168.2 |
Secondary
Change in Bleeding on Probing Index (BOP)
The bleeding on probing index (BOP) will be determined by assigning + to the presence of bleeding on vestibular / palatine probing of the tooth examined and with a sign - the abscence. Later the + signs will be summed and divided by the number of sites examined. Change in BOP: baseline measure minus 1 month later measure.
Time frame: baseline and 1 month after intervention
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Atorvastatin Toothpaste | Change in Bleeding on Probing Index (BOP) | 64.42 percentage of BOP | Standard Deviation 18.08 |
| Non Medicated Gel Toothpaste | Change in Bleeding on Probing Index (BOP) | 28.56 percentage of BOP | Standard Deviation 15.56 |
Secondary
Change in Clinical Attachment Level (CAL)
The Clinical Attachment Level (CAL) is defined as the distance from the cement-enamel junction to the fornix of the pocket. For each tooth will be performed periodontal probing at 6 sites (mesiobuccal, mediobuccal, distobuccal mesiolingual / palatal mediolingual / distolingual palatal / lingual). Change in CAL: baseline measure minus 1 month later measure.
Time frame: baseline and 1 month after intervention
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Atorvastatin Toothpaste | Change in Clinical Attachment Level (CAL) | 0.89 millimeters | Standard Deviation 0.33 |
| Non Medicated Gel Toothpaste | Change in Clinical Attachment Level (CAL) | 0.49 millimeters | Standard Deviation 0.31 |
Secondary
Change in Gingival Index
Determined as score assigned to each site evaluated respect to clinical criteria as followed: Score Criteria: 0\. No inflammation 1. Mild inflammation, slight change in color, slight edema, no bleeding on probing. 2. Moderate inflammation, moderate glazing, redness, bleeding on probing. 3. Severe inflammation, marked redness and hypertrophy, ulceration, tendency to spontaneous bleeding. Then was calculated a score for each sextant summed the score and divided by the number of examined sites. Later was summed each sextant score and divided by sextant evaluated. The change was calculated as baseline measure minus 1 month later measure.
Time frame: baseline and 1 month after intervention
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Atorvastatin Toothpaste | Change in Gingival Index | 1.04 score on a scale | Standard Deviation 0.54 |
| Non Medicated Gel Toothpaste | Change in Gingival Index | 0.54 score on a scale | Standard Deviation 0.42 |
Secondary
Change in Mean Pocket Depth (PD)
The PD will be defined as the distance from the free gingival margin to the bottom of the pocket. For each tooth will be conducted periodontal probing at 6 sites (mesiobuccal, mediobuccal, distobuccal, mesiolingual / palatal, mediolingual / palatal, distolingual/ palatal). Change in mean PD: baseline measure minus 1 month later measure.
Time frame: baseline and 1 month later
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Atorvastatin Toothpaste | Change in Mean Pocket Depth (PD) | 1.29 millimeters | Standard Deviation 0.45 |
| Non Medicated Gel Toothpaste | Change in Mean Pocket Depth (PD) | 0.70 millimeters | Standard Deviation 0.53 |