الفهرس 
Introduction .Only 14 pages are availabe for public view
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Abstract
P
eriodontitis is an ongoing inflammatory reaction to oral biofilm. Clinical signs of the disease include loss of connective tissue attachment and bone around the teeth, as well as the formation of periodontal pockets due to apical migration of the junctional epithelium. MMP and cytokines are examples of inflammatory mediators that are produced as part of the host response and contribute to tissue destruction.
Pro-inflammatory and anti-inflammatory cytokines are part of the cytokine network that mediates the immune response. Numerous pro-inflammatory cytokines, such as IL-1β, IL-6, and TNF-α, are released from junctional epithelia, connective tissue fibroblasts, and macrophages during the initiation of an inflammatory response in the periodontal connective tissue. Furthermore, PMNs and osteoclasts produce enzymes such as MMP-8 and -9, which cause the degradation of connective tissue collagen and alveolar bone.
The receptor activator of nuclear factor-K ligand (RANKL)/osteoprotegerin (OPG) ratio has been found to increase in inflamed periodontal tissues, either due to an increase in RANK or a decrease in OPG, or both. When gingival crevicular fluid from patients with chronic periodontitis or aggressive periodontitis is compared to that from gingivitis or healthy patients, the RANKL/OPG ratio is higher. These findings identify a promising therapeutic target and have prompted the development and use of drugs that modulate the RANKL/RANK/OPG axis, resulting in an increase in OPG and a decrease in RANKL, consistent with a state of equilibrium between bone formation and bone destruction.
Mechanical debridement is the first step in the treatment of periodontitis, which disturbs the biofilm and reduces the bacterial load. In some cases, the base of deep pockets of periodontitis is difficult to access with periodontal instrumentation, making mechanical methods insufficient. To avoid periodontal surgeries for deep pockets, it is recommended that systemic or local chemotherapeutic agents be administered. Several local drug delivery (LDD) systems have been developed to avoid the negative effects of systemic antibiotic administration. Chlorhexidine, Tetracycline, and Metronidazole are examples of LDD that are used as an adjunctive aid in the treatment of periodontal diseases.
Previous research has shown that when compared to a systemic drug regimen, the local route of drug delivery can achieve 100-fold higher concentrations of an antimicrobial agent in subgingival sites. The current study considered the benefits of local drug delivery, such as high concentrations at the target site with reduced dosage, fewer applications, and high patient acceptability, as a technique of direct subgingival injection of MF into periodontal pockets of chronic periodontitis patients with intrabony defects.
Metformin (MF) is a biguanide and one of the most commonly used oral hypoglycemic drugs in type 2 diabetes. MF reduces both basal and postprandial plasma glucose by inhibiting glucose production by hepatic cells in the liver; glucose absorption by intestinal cells is reduced, and glucose uptake and utilization are improved. Aside from lowering blood glucose levels, MF may have additional benefits such as weight loss, lower plasma lipid levels, and the prevention of some vascular complications. Other indications for MF include polycystic ovary syndrome.
In this study 40 patients having stage III periodontitis were candidates, they were divided into 2 groups with the aim of evaluating the effect of using Metformin as an adjunct to non-surgical treatment of periodontitis and also to evaluate the level of RANKL and OPG after 1 month. The study concluded that the use of Metformin as an adjunctive aid to mechanical debridement improve clinical parameters.
The use of Metformin as an adjunctive aid to mechanical debridement is a promising LDD that may lead to improvement in clinical parameters if used several times during healing stage. OPG levels in the study groups showed higher concentrations at 1 month which ensure the resolution of periodontal inflammation.
Both groups showed significant improvement in each of the clinical outcomes, and the percentage of improvement in periodontal pocket measurement was (66.45%) and the level of clinical attachment level (32.81%) in the first group and percentage of improvement in periodontal pocket measurement was (53.78%) and the level of clinical attachment level (16.00 %) in the second group, also the percentage of improvement in the level of RANKL and OPG was (44.12%) and (189.73%) in the first group, and (19.90%) and (57.59%) in the second group.