Periodontitis: Metformin May Be an Effective Local Treatment

Laird Harrison

August 22, 2013

Metformin, a drug used for diabetes, can also effectively treat chronic periodontitis in smokers, a new study shows.

Administered in a 1% gel, the drug increased bone fill 26.17% (± 6.66%) compared with only 3.75% (± 8.06%) for a placebo when both were combined with scaling and root planing.

It also reduced probing depth and increased clinical attachment levels more than placebo.

"This information can provide a new direction in the field of periodontal regeneration," conclude Nishanth S. Rao, MDS, from the Department of Periodontics, Government Dental College and Research Institute, Fort, Bangalore, India, and colleagues, who conducted their study at the Government Dental College and Research Institute.

The researchers published their results in the August issue of the Journal of Periodontology.

Clinicians have used metformin to treat diabetes since the 1950s, the authors note. Although its exact mechanism of action remains unclear, it appears to increase insulin sensitivity.

Among other benefits, it has been shown to reduce bone fracture in diabetics and has stimulated bone-producing cells in laboratory cultures. In another study, it reduced alveolar bone loss in rats with ligature-induced periodontitis.

To test its effects on humans with chronic periodontitis, the researchers recruited 50 male smokers with sites of probing depths of at least 5 mm, clinical attachment levels of at least 4 mm, and vertical bone loss of at least 3 mm. They excluded patients with diabetes or aggressive periodontitis.

The researchers treated all patients with scaling and root planing and randomly assigned them to receive either a placebo or metformin.

They injected 10 μL of 1% metformin gel from a syringe into periodontal pockets in the metformin group. They instructed the patients to refrain from chewing hard, brushing near the treated areas, or using interdental aids for 1 week.

The patients received no antibiotics or anti-inflammatory drugs. Forty-five patients completed the study: 23 in the placebo group and 22 in the metformin group.

After 6 months, probing depth decreased in the metformin group a mean of 3.17 mm (± 0.75 mm) compared with 0.87 mm (± 0.94 mm) in the placebo group. Clinical attachment levels increased a mean of 3.27 mm (± 0.79 mm) in the metformin group compared with 1.47 mm (± 0.78 mm) in the placebo group, and intrabony defect depth decreased 1.32 mm (± 0.4 mm) in the metformin group compared with 0.22 (± 0.38 mm) in the placebo group. The differences were all statistically significant (P < .001).

The authors note that they had conducted previous research to determine the optimum dose of metformin. They found that 1% and 1.5% solutions produced similar improvement in clinical parameters and achieved similar concentrations in gingival crevicular fluid, so they settled on 1% for this study.

The authors call their findings an "eye-opener to the bone-formative effects" of metformin."However, a long-term, multicenter, randomized controlled clinical trial will be required to assess its clinical, histologic, and radiographic effect on bone healing," they add.

The authors have disclosed no relevant financial relationships.

J Periodontol. 2013;84:1165-1171. Abstract

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