Efficacy Of Supplementary Melatonin as Adjunct to Surgical Periodontal Therapy on Periodontal Parameters: A Pilot Study

Main Article Content

Iram Rafique Pawane
Sankari Malaiappan

Keywords

Dysbiosis, Inflammation, Melatonin, Periodontal disease

Abstract

Aim: To evaluate the effect of two dosages of systemically administered melatonin compared to a placebo on clinical parameters in adjunct to regenerative surgical periodontal therapy.
Material And Methods: 30 subjects with Stage III Grade A/B periodontal disease indicated for surgical periodontal therapy were recruited. Group I received 3mg melatonin (n=10), group II received 6 mg melatonin (n=10) and the control group received a placebo (n=10), once a day, for one month. Clinical parameters assessed: Probing Depth (PD), Clinical Attachment Levels (CAL), Gingival Index (GI) and Plaque Index (PI) evaluated at 3 months from baseline. Obtained data analysis done using SPSS software version 23 (Statistical Package for the Social Sciences, SPSS, version 21). Data normality tested using Shapiro-Wilk and Kolmogrov Smirnov tests. One way Anova test was done for intergroup analysis, paired-t test was used to compare all the parameters between different time intervals within each group. In all the tests, the p value of < 0.05 was considered to be statistically significant.
Results: All groups showed significant improvement at follow up in the intra-group analysis on all clinical outcomes. A one-way ANOVA test was performed to evaluate the effect on clinical outcomes between each group. Tukey’s HSD comparisons found a statistically significant difference in both intervention groups compared to placebo in PD reduction and gingival index values (p< 0.05). However, 6 mg melatonin was seen to have higher differences compared to 3mg melatonin and placebo group in CAL outcomes.
Conclusion: Oral administration melatonin after surgical periodontal management resulted in significant improvement in clinical parameters. 6mg melatonin was more effective in improving clinical parameters compared to 3mg melatonin. However, further studies involving a longer follow up period would be desirable to substantiate the current results.

Abstract 228 | PDF Downloads 191

References

1. Abdulkareem AA, Al-Taweel FB, Al-Sharqi AJB, et al. Current concepts in the pathogenesis of periodontitis: from symbiosis to dysbiosis. J Oral Microbiol 2023; 15: 2197779.
2. Buduneli N. Pathogenesis and Treatment of Periodontitis. BoD – Books on Demand, 2012.
3. Genco RJ. Molecular Pathogenesis of Periodontal Disease. 1994.
4. Teja KV, Ramesh S, Priya V. Regulation of matrix metalloproteinase-3 gene expression in inflammation: A molecular study. J Conserv Dent 2018; 21: 592–596.
5. Bostanci N, Belibasakis GN. Pathogenesis of Periodontal Diseases: Biological Concepts for Clinicians. Springer, 2017.
6. Wang C, Wang L, Wang X, et al. Beneficial Effects of Melatonin on Periodontitis Management: Far More Than Oral Cavity. Int J Mol Sci; 23. Epub ahead of print 22 November 2022. DOI: 10.3390/ijms232314541.
7. Dos Santos RM, Belardi BE, Tsosura TVS, et al. Melatonin decreases IRF-3 protein expression in the gastrocnemius muscle, reduces IL-1β and LPS plasma concentrations, and improves the lipid profile in rats with apical periodontitis fed on a high-fat diet. Odontology. Epub ahead of print 25 December 2022. DOI: 10.1007/s10266-022-00782-w.
8. Dos Santos RM, Tsosura TVS, Belardi BE, et al. Melatonin decreases plasma TNF-α and improves nonenzymatic antioxidant defence and insulin sensitivity in rats with apical periodontitis fed a high-fat diet. Int Endod J 2023; 56: 164–178.
9. Liu R-Y, Li L, Zhang Z-T, et al. Clinical efficacy of melatonin as adjunctive therapy to non-surgical treatment of periodontitis: a systematic review and meta-analysis. Inflammopharmacology 2022; 30: 695–704.
10. Deandra FA, Ketherin K, Rachmasari R, et al. Probiotics and metabolites regulate the oral and gut microbiome composition as host modulation agents in periodontitis: A narrative review. Heliyon 2023; 9: e13475.
11. Solá VM, Aguilar JJ, Farías A, et al. Melatonin protects gingival mesenchymal stem cells and
promotes differentiation into osteoblasts. Cell Biochem Funct 2022; 40: 636–646.
12. Wadhwa R, Paudel KR, Chin LH, et al. Anti-inflammatory and anticancer activities of Naringenin-loaded liquid crystalline nanoparticles in vitro. J Food Biochem 2021; 45: e13572.
13. Reddy P, Krithikadatta J, Srinivasan V, et al. Dental Caries Profile and Associated Risk Factors Among Adolescent School Children in an Urban South-Indian City. Oral Health Prev Dent 2020; 18: 379–386.
14. Eapen BV, Baig MF, Avinash S. An Assessment of the Incidence of Prolonged Postoperative Bleeding After Dental Extraction Among Patients on Uninterrupted Low Dose Aspirin Therapy and to Evaluate the Need to Stop Such Medication Prior to Dental Extractions. J Maxillofac Oral Surg 2017; 16: 48–52.
15. Devarajan Y, Nagappan B, Choubey G, et al. Renewable Pathway and Twin Fueling Approach on Ignition Analysis of a Dual-Fuelled Compression Ignition Engine. Energy Fuels 2021; 35: 9930–9936.
16. Barabadi H, Mojab F, Vahidi H, et al. Green synthesis, characterization, antibacterial and biofilm inhibitory activity of silver nanoparticles compared to commercial silver nanoparticles. Inorganic Chemistry Communications 2021; 129: 108647.
17. Manickam A, Devarasan E, Manogaran G, et al. Score level based latent fingerprint enhancement and matching using SIFT feature. Multimed Tools Appl 2019; 78: 3065–3085.
18. Subramaniam N, Muthukrishnan A. Oral mucositis and microbial colonization in oral cancer patients undergoing radiotherapy and chemotherapy: A prospective analysis in a tertiary care dental hospital. Journal of Investigative and Clinical Dentistry; 10. Epub ahead of print 2019. DOI: 10.1111/jicd.12454.
19. Rohit Singh T, Ezhilarasan D. Ethanolic Extract of Lagerstroemia Speciosa (L.) Pers., Induces Apoptosis and Cell Cycle Arrest in HepG2 Cells. Nutr Cancer 2020; 72: 146–156.
20. Wahab PUA, Abdul Wahab PU, Senthil Nathan P, et al. Risk Factors for Post-operative Infection Following Single Piece Osteotomy. Journal of Maxillofacial and Oral Surgery 2017; 16: 328–332.
21. Krishnamurthy A, Sherlin HJ, Ramalingam K, et al. Glandular odontogenic cyst: report of two cases and review of literature. Head Neck Pathol 2009; 3: 153–158. 22. Rajasekar A, Varghese SS. Microbiological Profile in Periodontitis and Peri-Implantitis: A Systematic Review. J Long Term Eff Med Implants 2022; 32: 83–94.
23. Dumitrescu AL. Etiology and Pathogenesis of Periodontal Disease. Springer, 2010.
24. Jiang T, Xia C, Chen X, et al. Melatonin promotes the BMP9-induced osteogenic differentiation of mesenchymal stem cells by activating the AMPK/β-catenin signalling pathway. Stem Cell Res Ther 2019; 10: 408.
25. Hardeland R. Mini-Reviews in Recent Melatonin Research. Cuvillier Verlag, 2017.
26. Maestroni GJM, Conti A, Reiter RJ. Therapeutic Potential of Melatonin. Karger Medical and Scientific Publishers, 1997.
27. Carpentieri AR, Peralta Lopez ME, Aguilar J, et al. Melatonin and periodontal tissues: Molecular and clinical perspectives. Pharmacol Res 2017; 125: 224–231.
28. Bazyar H, Zare Javid A, Zakerkish M, et al. Effects of melatonin supplementation in patients with type 2 diabetes mellitus and chronic periodontitis under nonsurgical periodontal therapy: A double-blind randomized controlled trial. J Res Med Sci 2022; 27: 52.
29. Anton D-M, Martu M-A, Maris M, et al. Study on the Effects of Melatonin on Glycemic Control and Periodontal Parameters in Patients with Type II Diabetes Mellitus and Periodontal Disease. Medicina 2021; 57: 140.
30. Meenakshi SS, Malaiappan S. Role of melatonin in periodontal disease - A systematic review. Indian J Dent Res 2020; 31: 593–600.
31. Najeeb S, Khurshid Z, Zohaib S, et al. Therapeutic potential of melatonin in oral medicine and periodontology. Kaohsiung J Med Sci 2016; 32: 391–396.
32. Kaparakis-Liaskos M, Kufer TA. Bacterial Membrane Vesicles: Biogenesis, Functions and Applications. Springer Nature, 2020.
33. Radio NM, Doctor JS, Witt-Enderby PA. Melatonin enhances alkaline phosphatase activity in differentiating human adult mesenchymal stem cells grown in osteogenic medium via MT2 melatonin receptors and the MEK/ERK (1/2) signaling cascade. J Pineal Res 2006; 40: 332–342.