Clinical efficacy of 1% alendronate gel in adjunct to mechanotherapy in the treatment of aggressive periodontitis: a randomized controlled clinical trial. Evaluation of an aminobisphosphonate (alendronate) in the management of periodontal osseous defects Comparative evaluation of subgingivally delivered 1% alendronate versus 1.2% atorvastatin gel in treatment of chronic periodontitis: a randomized placebo‐controlled clinical trial† Comparative evaluation of autologous platelet-rich fibrin and platelet-rich plasma in the treatment of 3-wall intrabony defects in chronic periodontitis: a randomized controlled clinical trial. One percent alendronate and aloe vera gel local host modulating agents in chronic periodontitis patients with class II furcation defects: A randomized, controlled clinical trial Effect of Alendronate with β - TCP Bone Substitute in Surgical Therapy of Periodontal Intra-Osseous Defects: A Randomized Controlled Clinical Trial. Evidence for cigarette smoking as a major risk factor for periodontitis. Mandibular Degree II Furcation Defects Treatment With Platelet‐Rich Fibrin and 1% Alendronate Gel Combination: A Randomized Controlled Clinical Trial 1% alendronate gel as local drug delivery in the treatment of Class II furcation defects: a randomized controlled clinical trial. Effect of 1% sodium alendronate in the non-surgical treatment of periodontal intraosseous defects: a 6-month clinical trial Autologous platelet-rich fibrin in the treatment of mandibular degree II furcation defects: a randomized clinical trial. Clinico‐radiographic evaluation of 1% alendronate gel as an adjunct and smart blood derivative platelet rich fibrin in grade II furcation defects
BACKGROUND Bisphosphonates represent a class of pharmacologic agents that have a potentially important role in the treatment of periodontitis and bone disorders . The present study aims to explore the clinical efficacy of 1 % alendronate ( ALN ) gel as a local drug delivery system in adjunct to scaling and root planing for the treatment of patients with aggressive periodontitis ( AgP ) compared to placebo gel . METHODS Fifty-two intrabony defects from 17 patients with AgP were treated either with 1 % ALN gel or placebo gel . ALN gel was prepared by adding ALN to a polyacrylic acid-distilled water mixture . Clinical parameters ( modified sulcus bleeding index , plaque index , probing depth [ PD ] , and clinical attachment level [ CAL ] ) were recorded at baseline , 2 months , and 6 months , and radiographic parameters were recorded at baseline and 6 months . Defect fill at baseline and at 6 months was calculated on st and ardized radiographs by using image analysis software . RESULTS Mean PD reduction was greater in the ALN group ( 3.88 ± 1.39 mm ) compared to placebo ( 1.65 ± 1.35 mm ) at 6 months . Similarly , mean CAL gain was greater in the ALN group ( 3.27 ± 1.11 mm ) than the placebo group ( 1.42 ± 1.70 mm ) at 6 months . Furthermore , significantly greater mean percentage of bone fill was found in the ALN group ( 46.1 % ± 9.48 % ) compared to the placebo group ( 2 % ± 1.02 % ) . CONCLUSIONS The results of the present study show local delivery of 1 % ALN stimulates a significant increase in PD reduction , CAL gain , and improved bone fill compared to placebo gel as an adjunct to scaling and root planing in patients with AgP. However , long-term , multicentered , r and omized , controlled clinical trials are required to know the clinical , histologic , and radiographic effect on bone regeneration in patients with Background and Objectives : Alendronate , an aminobisphosphonate , is capable of inhibiting periodontitis associated osteoclastic activity and hence is effective in protecting the alveolar bone in periodontitis . In the present study , we explored the efficacy of local delivery of alendronate on the alveolar bone following mucoperiosteal flap surgery . This is the first study to use polymer impregnated gel based delivery of alendronate . Material s and Methods : A total of 15 patients with chronic periodontitis in the age group of 35 - 55 years , of both sexes , with pocket depth of ≥ 5 mm and radiographic evidence of identical osseous defects in the m and ibular molar region bilaterally were included in this prospect i ve study . A gel based drug delivery system of Alendronate was formulated . Following surgical flap debridement , 0.1 ml alendronate gel and 0.1 ml placebo gel was placed at the experimental and control sites respectively . Clinical and radiographic parameters were recorded at baseline , three months and six months post surgery . Results : Alendronate was more effective in improving clinical and radiographic parameters  compared to placebo . Interpretation and Conclusion : Alendronate is effective in the management of periodontitis associated bone loss . Gel based local delivery of the drug addresses the critical concern of exposing the patient to adverse effects of systemic administration AIM Alendronate ( ALN ) and atorvastatin ( ATV ) are known to inhibit osteoclastic bone resorption and were proposed to have osteostimulative properties . The aim of the study was to evaluate and compare the efficacy of 1 % ALN and 1.2 % ATV gel as a local drug-delivery system in adjunct to scaling and root planning ( SRP ) for the treatment of intrabony defects in chronic periodontitis patients . METHODS A total of 90 intrabony defects were treated with either 1 % ALN , 1.2 % ATV , or placebo gel . Clinical parameters ( plaque index , modified sulcus bleeding index , probing depth ( PD ) , and clinical attachment level ( CAL ) ) were recorded at baseline , 3 , 6 , and 9 months . Intrabony defect depth ( IBD ) and defect depth reduction ( DDR% ) was calculated on st and ardized radiographs at 6 and 9 months . RESULTS The mean PD reduction , CAL gain , and DDR% were greater in the ALN and ATV group than in the placebo group at 3 , 6 , and 9 months . Furthermore , a significantly greater DDR% was found in the ALN group at 6 and 9 months than in the ATV and placebo groups . CONCLUSION Local delivery of 1 % ALN results in significantly greater improvement in PD , CAL , IBD depth , and DDR% as compared to 1.2 % ATV gel BACKGROUND The topical use of platelet concentrates is recent , and its efficiency remains controversial . The present study aims to explore the clinical and radiographic effectiveness of autologous platelet-rich fibrin ( PRF ) and platelet-rich plasma ( PRP ) in the treatment of intrabony defects in patients with chronic periodontitis . METHODS Ninety intrabony defects were treated with either autologous PRF with open-flap debridement or autologous PRP with open-flap debridement or open-flap debridement alone .  Clinical and radiologic parameters , such as probing depth ( PD ) , clinical attachment level ( CAL ) , intrabony defect depth , and percentage defect fill , were recorded at baseline and 9 months postoperatively . RESULTS Mean PD reduction and CAL gain were greater in PRF ( 3.77 ± 1.19 and 3.17 ± 1.29 mm ) and PRP ( 3.77 ± 1.07 and 2.93 ± 1.08 mm ) groups than the control group ( 2.97 ± 0.93 and 2.83 ± 0.91 mm ) . Furthermore , significantly greater percentage of mean bone fill was found in the PRF ( 55.41 % ± 11.39 % ) and PRP ( 56.85 % ± 14.01 % ) groups compared with the control ( 1.56 % ± 15.12 % ) group . CONCLUSIONS Within the limit of the present study , there was similar PD reduction , CAL gain , and bone fill at sites treated with PRF or PRP with conventional open-flap debridement . Because PRF is less time consuming and less technique sensitive , it may seem a better treatment option than PRP . However , long-term , multicenter r and omized , controlled clinical trials will be required to know their clinical and radiographic effects on bone regeneration AIM Alendronate ( ALN ) has antiresorptive and osteostimulative properties . The major component of aloe vera ( AV ) gel is acemannan , which has been found to have osteogenic properties . The aim of the present study is to explore the effectiveness of 1 % ALN and AV gel as an adjunct to scaling and root planing ( SRP ) in chronic periodontitis patients with class II furcation defects . METHODS Ninety volunteers were r and omly assigned to three treatment groups : ( a ) SRP plus placebo gel ; ( b ) SRP plus 1 % ALN gel ; and ( c ) SRP plus AV gel . Clinical and radiographic parameters were recorded at baseline and at 6 and 12 months . RESULTS The mean probing depth reduction and relative horizontal clinical attachment level ( CAL ) and relative vertical CAL gains were greater in the ALN group than in the AV and placebo groups at 6 and 12 months . Furthermore , a significantly greater mean percentage of defect depth reduction ( DDR ) was found in the ALN group ( 38.09 ± 9.53 , 44.86 ± 6.29 ) than the AV groups ( 11.94 ± 15.10 , 14.59 ± 25.49 ) at 6 and 12 months , respectively . CONCLUSION ALN showed significant improvement in all clinical parameters , along with greater DDR , compared to AV in the treatment of class II furcation defects as an adjunct to SRP INTRODUCTION Alendronate ( ALN ) , an aminobisphosphonate , inhibits osteoclastic bone resorption and also stimulates osteogenesis . Beta-Tricalcium Phosphate ( β-TCP ) is an osteoconductive graft material which provides a scaffold for bone formation and also a widely used drug delivery vehicle for growth factors and antibiotics . Drug delivery vehicles , like β-TCP , improve the potency of the drugs by specific local site delivery of the drug , optimal release characteristics and easy h and ling . AIM The aim of the this study was to evaluate the bone formation potential of 400μg ALN delivered in β-TCP in the treatment of periodontal intra-osseous defects . MATERIAL S AND METHODS Thirty patients with periodontal defects were r and omly assigned to 400μg ALN + β-TCP + Saline ( test ) group and β-TCP + Saline ( active-control ) group . Clinical parameters like Clinical Attachment Level ( CAL ) gain , Probing Depth ( PD ) reduction , post-operative Gingival Recession ( GR ) were assessed from the baseline , 3 months and 6 months recordings . Radiographic parameters like Linear Bone Growth ( LBG ) , Percentage Bone Fill ( % BF ) , and change in alveolar crest height ( ACH ) were assessed from baseline and 6 months radiographs . RESULTS Mean measurements in the ALN test group for CAL gain ( 3.4 ± 0.74 mm ) , PD reduction ( 4.33 ± 0.82 mm ) , LBG ( 2.88 ± 0.88 mm ) , and % BF ( 51.98 ± 15.84 % ) were significantly greater with a p-value < 0.05 compared to the mean measurements of CAL gain ( 2.20 ± 0.86 mm ) , PD reduction ( 3.20 ± 1.15 mm ) , LBG ( 1.70 ± 0.39 mm ) , and % BF ( 30.35 ± 6.88 % ) of the control group . There was mild alveolar crestal apposition ( 0.32 ± 0.68 mm ) in the ALN test group and mild alveolar crestal resorption ( -0.24 ± 0.40 mm ) in the control group . CONCLUSION 400μg ALN combined with β-TCP bone graft material was effective in improving soft tissue parameters , inhibiting alveolar crestal resorption and enhancing bone formation , compared to β-TCP alone The role of smoking as a risk factor for periodontitis was assessed separately in diabetic and nondiabetic study groups . Subject listings stratified for age ( 19 to 40 years ) and sex were obtained for subjects with insulin-dependent diabetes mellitus ( IDDM ) and nondiabetic subjects . For both the IDDM group ( n = 132 ) and the nondiabetic group ( n = 95 ) , age and sex stratified sample s were constructed by r and om selection of subjects from each subject listing . Patients were recruited by phone , examined , and their medical and dental histories obtained . Among nondiabetic subjects , the prevalence of periodontitis was markedly higher among current smokers compared with never smokers ( P < or = 0.005 ) in both the 19 to 30 year-old ( 46 % vs. 12 % ) and 31 to 40 year-old groups ( 88 % vs. 33 % ) . The subject mean percent of sites with gingival pocket depth > or = 4 mm was higher among current smokers than never smokers ( P = 0.001 ) in the 19 to 30 ( 8.2 % vs. 3.4 % ) and 31 to 40 ( 14.3 % vs. 4.3 % ) age groups . The effects of smoking among IDDM subjects were similar to that observed in the nondiabetic population . There were no differences between current and never smokers in the proportion of sites positive for plaque . Attributable risk percents from prevalence data suggest that among nondiabetic subjects , a large proportion , perhaps as much as 51 % of the periodontitis in the 19 to 30 year old group and 32 % of the periodontitis in the 31 to 40 year old group , is associated with smoking . ( ABSTRACT TRUNCATED AT 250 WORDS BACKGROUND Different material s have been investigated for renewal of lost supporting periodontal structures and tested for furcation defect treatment . Platelet-rich fibrin ( PRF ) is a pool of growth-promoting factors and cytokines that promote bone regeneration and maturation of soft tissue . Alendronate ( ALN ) , an influential member of the bisphosphonate group , is known to enhance osteoblastogenesis and inhibit osteoclastic bone resorption , thus promoting tissue regeneration . This r and omized trial was done to assess effectiveness of PRF and 1 % ALN gel combination in m and ibular degree II furcation defect treatment in comparison with PRF and access therapy alone . METHODS Seventy-two m and ibular molar furcation defects were treated with either access therapy alone ( group 1 ) , access therapy with PRF ( group 2 ) , or access therapy with PRF and 1 % ALN ( group 3 ) . Plaque index , modified sulcus bleeding index , probing depth ( PD ) , relative vertical attachment level ( RVAL ) and relative horizontal attachment level ( RHAL ) , and intrabony defect depth were recorded at baseline and 9 months postoperatively . Radiographically , defect fill , assessed in percentage , was evaluated at baseline , before surgery , and 9 months post-therapy . RESULTS Group 3 showed greater PD reduction and RVAL and RHAL gain when compared with groups 1 and 2 postoperatively . Moreover , group 3 sites showed a significantly greater percentage of radiographic defect fill ( 56.01 % ± 2.64 % ) when compared with group 2 ( 49.43 % ± 3.70 % ) and group 1 ( 10.25 % ± 3.66 % ) at 9 months . CONCLUSIONS Furcation defect treatment with autologous PRF combined with 1 % ALN gel results in significant therapeutic outcomes when compared with PRF and access therapy alone . Combining ALN with PRF has potential for regeneration of furcation defects without any adverse effect on healing process BACKGROUND Alendronate ( ALN ) , an aminobisphosphonate , is known to stimulate the formation of osteoblast precursors to promote osteoblastogenesis . The present study aims to explore the efficacy of 1 % ALN gel as a local drug delivery system in adjunct to scaling and root planing ( SRP ) for the treatment of Class II furcation defects in comparison with placebo gel . METHODS A total of 69 m and ibular Class II furcation defects were r and omized and treated with either 1 % ALN gel or placebo gel . Clinical parameters were recorded at baseline , 3 months , 6 months , and 12 months , and radiographic parameters were recorded at baseline , 6 months , and 12 months . Defect fill at baseline , 6 months , and 12 months was calculated on st and ardized radiographs using image analysis software . RESULTS Mean probing depth ( PD ) reduction and mean relative vertical ( RVCAL ) and horizontal ( RHCAL ) clinical attachment level gain were shown to be greater in the ALN group than the placebo group at 3 , 6 , and 12 months . Furthermore , a significantly greater mean percentage of bone fill was found in the ALN group ( 32.11 % ± 6.18 % , 32.66 % ± 5.86 % ) , compared with the placebo group ( 2.71 % ± 0.61 % , 1.83 % ± 1.51 % ) , at 6 and 12 months , respectively . CONCLUSIONS The results of the present study show that local delivery of 1 % ALN into a Class II furcation defect stimulates a significant PD reduction , RVCAL and RHCAL gains , and improved bone fill compared with placebo gel as an adjunct to SRP . ALN can provide a new direction in management of furcation defects Abstract Background and objectives Few studies have evaluated the effect of the topical application of sodium alendronate ( ALN ) on the treatment of intrabuccal bone defects , especially those caused by periodontitis . This 6-month r and omized placebo controlled clinical trial aim ed at evaluating the effect of non-surgical periodontal treatment associated with the use of 1 % ALN , through clinical evaluations and cone-beam computed tomography ( CBCT ) . Material and Methods Twenty individuals with chronic periodontitis underwent periodontal examination at the baseline as well as 3 and 6 months after periodontal treatment , registering clinical attachment level ( CAL ) , periodontal probing depth ( PPD ) , and bleeding on probing ( BOP ) as the clinical outcomes . After manual scaling and root planing , 40 bilateral sites with interproximal vertical bone defects were r and omly treated with either 1 % ALN gel or a placebo .  Bone defects were evaluated through CBCT at the baseline and 6 months post-treatment . The clinical and CBCT parameters were compared using the Wilcoxon and Friedman tests ( p<0.05 ) . Results Although ALN produced a greater CAL gain when compared to the placebo at 6 months post-treatment ( p=0.021 ) , both treatments produced similar effects on the PPD , BOP , and bone height . Significant differences in bone fill were observed only in patients of the ALN group ( 4.5 to 3.8 mm ; p=0.003 ) at 6 months post-treatment . Conclusions Topical application of 1 % ALN might be a beneficial adjuvant to non-surgical periodontal therapy BACKGROUND Platelet-rich fibrin ( PRF ) , an intimate assembly of cytokines , glycan chains , and structural glycoproteins enmeshed within a slowly polymerized fibrin network , has the potential to accelerate soft and hard tissue healing . This double-masked r and omized study is design ed to evaluate the effectiveness of autologous PRF in the treatment of m and ibular degree II furcation defects compared with open flap debridement ( OFD ) . METHODS Using a split-mouth design , 18 patients with 36 m and ibular degree II furcation defects were r and omly allotted and treated either with autologous PRF and OFD or OFD .  Plaque index , sulcus bleeding index , probing depth , relative vertical and horizontal clinical attachment level , gingival marginal level , and radiographic bone defect were recorded at baseline and 9 months postoperatively . Comparison between indices between the test and control groups was performed using the paired t test except for plaque index and sulcus bleeding index data , which used the χ(2 ) test . RESULTS All clinical and radiographic parameters showed statistically significant improvement at the sites treated with PRF and OFD compared to those with OFD alone . CONCLUSION Within the limitation of this study , significant improvement with autologous PRF implies its role as a regenerative material in the treatment of furcation defects BACKGROUND The treatment of molar furcation involvement is unpredictable due to the complex anatomy and poor access for instrumentation . Previous studies have reported successful regeneration with endogenous regenerative material such as platelet rich fibrin ( PRF ) and bisphosphonates as alendronate ( ALN ) . Hence , the present study was aim ed to evaluate clinical ly and radiographically the efficacy of 1 % ALN gel in combination with PRF ( PRF+ALN ) and PRF alone in the treatment of grade II furcation defects . METHODS A split mouth study with 40 bilateral furcation defects was r and omly divided into PRF group and PRF+ALN group . Bone defect volume was the primary outcome evaluated at the end of 6 months with CBCT while the secondary outcomes being changes in clinical parameters including Probing pocket depth ( PPD ) , Clinical attachment level ( CAL ) and Horizontal probing depth ( HPD ) recorded at baseline , 3 and 6 months . RESULTS The mean reduction in PPD , CAL and HPD was 1.85 ± 0.59 mm , 1.9 ± 0.64 mm and 1.7 ± 0.73 mm respectively for PRF group and 2.85 ± 0.88 mm , 3.05 ± 0.98 mm and 2.3 ± 0.73 mm respectively for PRF+ ALN group ( p < 0.05 ) . At the end of 6 months , mean reduction in bone defect volume  for PRF and PRF+ ALN group was 8.65 ± 3.84 mm3 and 11.98 ± 4.13 mm3 respectively . CONCLUSION PRF+ ALN treated defects exhibited better clinical and radiographic outcomes suggestive of enhanced periodontal regeneration when compared to PRF alone treated sites
Periodontal bone regeneration relies on coupled and cooperative bone formation and resorption .
Accordingly a novel strategy on concurrent use of platelet-rich fibrin ( PRF ) ( anabolic agent ) and 1 % alendronate ( ALN ) ( anticatabolic agent ) was proposed recently in regenerative periodontal treatment .
It was supposed to enhance bone formation and reduce bone resorption simultaneously .
However , there is a lack of evidence -based studies to answer whether this concurrent application was superior to single application until now .
Besides , concerns on ALN lead to some reservation on this synergistic way .
ALN may impair new bone formation and necrotize jaws .
Thus , in order to compare the clinical efficacy between PRF plus 1%ALN and PRF alone on periodontal bone regeneration , we performed present systematic review and meta- analysis .