Effects of Resveratrol Supplementation as an Adjunct to Nonsurgical Periodontal Therapy: A Systematic Review and Meta-analysis

Introduction/Objective Periodontitis is a chronic inflammatory disease affecting the supporting structures of teeth, and its successful management is critical to preserving oral health. Non-surgical periodontal therapy (NSPT) remains the standard of care; however, adjunctive therapies are being explored to enhance treatment outcomes. Omega-3 fatty acids possess anti-inflammatory properties that may offer additional therapeutic benefits in periodontal disease. This study aims to systematically evaluate the impact of omega-3 fatty acid supplementation in conjunction with NSPT on key clinical periodontal parameters, specifically probing pocket depth (PPD) and clinical attachment level (CAL), in systemically healthy patients with periodontitis. Methods/Case Report A systematic review and meta-analysis were conducted following PRISMA guidelines. A comprehensive search of four databases—PubMed, Google Scholar, Scopus, and Web of Science—identified 460 publications related to omega-3 fatty acids and periodontal disease. Inclusion criteria were randomized controlled trials (RCTs) involving systemically healthy patients with periodontitis, comparing non-surgical periodontal therapy (NSPT) combined with omega-3 supplementation to NSPT with placebo, and with a minimum follow-up of 3 months. Five RCTs met the eligibility criteria, comprising 101 patients in the omega-3 group and 99 in the placebo group. Meta-analysis was performed using REVMAN 5.3 with a random-effects model to assess changes in clinical attachment level (CAL) and probing pocket depth (PPD). Study quality and risk of bias were evaluated using the Cochrane risk-of-bias tool. Results The meta-analysis demonstrated that the adjunctive use of omega-3 fatty acids with non-surgical periodontal therapy (NSPT) led to statistically significant improvements in periodontal outcomes. A significant reduction in probing pocket depth (PPD) was observed in the omega-3 group compared to placebo (Z = 2.04, P = 0.04), despite moderate heterogeneity among studies (I² = 67%). Additionally, clinical attachment level (CAL) improved significantly in patients receiving omega-3 supplementation (Z = 2.04, P = 0.04; I² = 72%). These findings indicate a positive impact of omega-3 fatty acids on periodontal healing and inflammation resolution when combined with NSPT. Conclusion The integration of omega-3 fatty acid supplementation with non-surgical periodontal therapy (NSPT) offers significant clinical advantages in the management of periodontitis. Patients receiving omega-3 supplements in addition to NSPT demonstrated greater reductions in probing pocket depth and improvements in clinical attachment level compared to NSPT alone. These findings support the adjunctive use of dietary omega-3 fatty acids as a beneficial, non-invasive strategy to enhance periodontal therapy outcomes. Further large-scale, long-term studies are warranted to confirm these benefits and inform clinical practice guidelines.

ObjectiveThis study sought to investigate the relationship between clinical response to nonsurgical periodontal therapy (NSPT) and serum changes in leukocyte count, fasting blood glucose, hemoglobin, hematocrit, creatinine, and uric acid in kidney transplant recipients (KTR).MethodologyA prospective study was performed on 20 KTRs. Periodontal and serum data were collected before and 90 days after NSPT, and delta values (Δ = after NSPT - before) were calculated. Periodontal assessment included periodontal probing depth (PPD), clinical attachment level (CAL), and bleeding on probing (BOP). Patients were classified based on the presence of periodontitis and then categorized into stages.ResultsPatients showed a reduction in the percentage of sites with PPD≥3mm, PPD≥4 mm and BOP, after NSPT. There was a direct correlation between the deltas of leukocyte count and CAL ≥3 mm (r=0.645, P=0.002) and BOP (r=0.663, P=0.001), and the deltas of uric acid and CAL ≥3 mm (r=0.562, P=0.010).ConclusionA good clinical response to NSPT may affect the reduction of serum levels of leukocyte count and uric acid, suggesting a beneficial effect on systemic health in KTR.

Clinical studies have shown that adjunctive use of hyaluronic acid (HA) as part of non-surgical periodontal treatment (NSPT) has led to favourable clinical outcomes. However, no systematic review and meta-analysis has been carried out recently and technical and patient factors have not been previously explored. Therefore, the aim of this systematic review and meta-analysis is to evaluate the clinical effects of topical- HA as an adjunct to NSPT on probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BoP) in periodontitis patients. Systematic literature searches using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) approach identified clinical studies involving randomized controlled trials (RCTs) and split-mouth designs involving adult periodontitis. The searches were performed across six databases (PubMed, Embase, Medline, Cochrane, Web of Science, Scopus, and Google Scholar). Of the 1479 articles identified from the initial searches, a total of 23 were included in this systematic review, and 12 studies were included in the meta-analysis and sub-group analyses. Based on the included studies, HA adjunctive therapy showed improvements in PD reduction (WMD of -0.46, 95 % Confidence Interval CI:0.89 to -0.04, P = 0.04), CAL gain (WMD of -0.35, 95 % CI:0.61 to -0.09, P = 0.01), and BoP reduction (WMD of -0.38, 95 % CI:0.78 to 0.01, P = 0.06). However, due to the heterogeneity of the included studies, further evidence were needed to support the improvement of HA adjunctive therapy outcomes due to wider prediction intervals (PD reduction 95 % prediction interval, PI:1.95 to 1.03; CAL enhancement 95 % PI -1.11 to 0.42; BoP reduction 95 % PI -1.35 to 0.59)Higher HA concentrations (0.8 %)showed more pronounced PD reduction. The overall quality of the included studies were moderate using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment tool. Although topical HA application may provide additional benefits when used with NSPT, the limited number of studies, risk of bias, heterogeneity and moderate quality of evidence indicate that further research is warranted to confirm these findings and establish more definitive clinical guidelines. HA showed promise as an adjunctive treatment in enhancing the clinical outcomes following NSPT.

Diabetes and periodontal therapy

Minimally invasive procedures were introduced in periodontics, which could enhance clinical outcomes and reduce post-operative discomfort. However, minimally invasive non-surgical periodontal therapy (MINST) as an alternative modality of conventional non-surgical root surface debridement has not been clearly evaluated by randomized controlled clinical trial. The present study aimed to investigate clinical outcomes and patients’ comfort feedback of MINST compared to conventional non-surgical periodontal therapy (CNST). Patients with moderate to severe periodontitis were included. Nine out of ten patients were recruited and completed the post-treatment re-evaluation in this study. Randomized split-mouth design, CNST and MINST on each side, was performed. Clinical parameters, including periodontal probing depth (PD), gingival recession (REC), clinical attachment level (CAL), and gingival bleeding on probing (BOP), were recorded on baseline, 1 month and 3 months post-treatment. Non-parametric statistics were used for analysis. PD, REC, CAL, and BOP were improved after treatment in both CNST and MINST groups. Comfort feedback and gingival recession showed better outcomes in the MINST group than in the CNST group. No statistical significance of parameters was found between CNST and MINST. Within the limitations, minimally invasive non-surgical periodontal therapy could be an alternative modality of conventional non-surgical periodontal therapy. Further studies are required to establish clinical protocol and evidence of MINST.

Aim:This study was designed to evaluate the resistin levels in GCF of patients with periodontitis and type 2 diabetes mellitus(T2DM) after non-surgical periodontal therapy and subantimicrobial dosage doxycycline(SDD).Subjects & Methods:Thirty periodontal sites within 24 patients with age ranged between(24-51) years old were selected for this study.Total of 30 periodontal sites were randomly divided into three groups;each group included ten periodontal sites:(group I):systemically healthy periodontitis patients who were received scaling and root planning (SRP),(group II):periodontitis patients with T2DM who were received SRP, and(group III):periodontitis patients with T2DM who were received SRP and SDD 20mg twice/day. All patients were examined with clinical periodontal parameters: plaque index(PI), gingival index(GI), probing depth(PD) and clinical attachment level(CAL).Patients in each groups underwent nonsurgical periodontal therapy combined with a maintenance program (including brushing with regular toothpaste). GCF samples were collected in all patients at baseline, one month as well as 3 months after periodontal therapy. Quantification of resistin in human samples was measured using resistin ELISA test. Results: Non-surgical periodontal therapy resulted in relative improvement in all clinical parameters as well as a decrease in resistin levels.In addition, GCF levels of resistin, PD , GI were greater reduction after non-surgical treatment in group III than group II.Conclusions:Non surgical periodontal therapy is found to be effective in the treatment of periodontitis patients with and without diabetes mellitus and also GCF resistin can be a useful biomarker to detect the periodontal disease condition.Also, adjunctive use of SDD showed more clinical benefit to patients with periodontitis by host response modulation.

BackgroundPeriodontal disease is polymicrobial in nature and to control the infection we need to target the inflammatory component. Nonsurgical periodontal therapy is used for mechanical debridement. Use of agents along with nonsurgical periodontal therapy is gaining momentum. Locally delivered agents like antibiotics and herbal products are used in nonsurgical and surgical periodontal therapy. Phytotherapy offers antioxidant, antimicrobial action and has less chances of drug resistance.ObjectiveThis study design compared locally delivered chlorhexidine (CHX) 1% gel and Citrus sinensis peel extract (CSPE) gel in the management localized periodontitis as an adjuvant treatment to scaling and root planing (SRP).Material and MethodForty‐six subjects diagnosed with Grade II/III localized periodontitis were randomly assigned into two groups. After thorough SRP, CSPE gel placement was done in the test group and 1% CHX gel in the control group. Clinical parameters measured were probing pocket depth (PPD), clinical attachment level (CAL) and microbiological analysis (bacterial culture from pocket sample) was done prior to SRP and at 60 days.ResultsBoth the 1% CHX and CSPE gel provide comparable outcome (p ≥ 0.05) in improvement of PPD, CAL and bacterial colony count. Statistically significant results were obtained in terms of PPD; p = 0.044 (test group) and p = 0037 (control group). CAL showed statistically significant results in test group with p = 0.044. Inter group and Intra group comparison of plaque index showed no statistical difference. Colony forming units (CFU) between the two groups (p = 0.001) was found statistically significant.ConclusionLocally delivered herbal CSPE gel can be an effective, economical,and antibacterial gel as an adjunctive treatment of periodontitis.

Laser biostimulation therapy (LBT) is suggested to have positive effects on periodontal healing. This study evaluated LBT with nonsurgical periodontal therapy (NSPT) in diabetes mellitus (DM) and systemic health (SH) conditions. Thirty periodontitis patients (15 with DM and 15 with SH) were included in the study, which had a split-mouth design, by applying LBT in the mouth of the same systemic condition. Thus, 4 study groups were formed, as 1) NSPT - DM: NSPT alone in DM, 2) NSPT + LBT - DM: NSPT + LBT application in DM, 3) NSPT - SH: NSPT alone in SH, and 4) NSPT + LBT - SH: NSPT + LBT application in SH. NSPT was performed on days 15, 30, 37, 44, 51, 58, and 65. LBT was performed 6 times on days 30, 37, 44, 51, 58, and 65 with an Nd:YAG laser. The plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment level (CAL) were assessed as the clinical parameters and recorded at baseline and days 30, 37, and 72. Gingival crevicular fluid levels of interleukin 1 beta (IL-1β) and IL-10 were evaluated by ELISA as the biochemical parameters at baseline and on days 30, 37, and 72. Clinical parameters had improved in all of the groups on day 72 (p < 0.01). PPD and CAL improved more in the DM group with NSPT and LBT group than in the DM group with NSPT without LBT on day 37 (p < 0.05). IL-1β decreased and IL-10 increased in all of the groups on day 72 (p < 0.01). This change was more evident in the DM group with NSPT and LBT than in the DM group with NSPT without LBT on day 7 (p < 0.05). These results revealed the short-term impacts of LBT on periodontal healing, which return to ineffectiveness with repeated irradiation. Therefore, it may be speculated that LBT via the protocol herein may have a short-term antiinflammatory contribution to NSPT, only in impaired healing conditions such as DM.

BackgroundThe bidirectional relationship between obesity and periodontitis has been well-established, and adipokines play a key role in this association. Among adipokines, salivary resistin has been relatively less studied as a potential marker of systemic inflammation in obese individuals with periodontitis. With the increasing burden of lifestyle diseases, understanding the effects of periodontal therapy on the systemic inflammatory status of obese individuals will aid in more comprehensive health management. Therefore, this study aimed to compare salivary resistin levels and periodontal parameters before and 12 weeks after non-surgical periodontal therapy (NSPT) in obese and non-obese individuals with generalized stage II grade B periodontitis.MethodsThis longitudinal study included 60 participants with periodontitis. Participants were divided into two groups based on body mass index (BMI): the obese group (Group I) with BMI ≥ 27.5 kg/m² and the non-obese group (Group II) with BMI ≤ 27.5 kg/m². At baseline, salivary resistin levels and periodontal parameters, including probing pocket depth (PPD), clinical attachment level (CAL), full mouth plaque score (FMPS), and full mouth bleeding score (FMBS), were assessed. All participants underwent NSPT, with no local or systemic antibiotics or adjunctive treatments. Salivary resistin levels and periodontal parameters were reassessed 12 weeks post-treatment.ResultsIntergroup comparisons revealed higher resistin levels and periodontal parameters in the obese group at baseline and at the 12-week follow-up. Both groups showed a significant reduction in salivary resistin levels and clinical parameters after NSPT (p value<0.05). Even though the obese group demonstrated a greater magnitude of improvement in several measures, including salivary resistin, FMPS and FMBS after NSPT (p value<0.05), the values remain high compared to the non-obese group. Moreover, the non-obese group demonstrated a significant reduction in THE PPD and CAL indicating a pronounced clinical recovery following NSPT (p value<0.05).ConclusionObesity contributes significantly to the severity of periodontitis by enhancing systemic inflammatory burden. NSPT effectively improved clinical periodontal health and reduced salivary resistin levels in individuals with periodontitis, regardless of obesity status. The obese group demonstrated more significant changes in salivary resistin levels following NSPT, but the clinical recovery in terms of PPD and CAL was better for the non-obese group. This study underscores the importance of integrating personalized periodontal care in obese individuals, along with other strategies aimed at reducing obesity associated inflammation to optimize long-term health outcomes.

AimOmega-3 polyunsaturated fatty acids (PUFA) possess anti-inflammatory and pro-resolving properties, suggesting potential benefits as adjuncts to non-surgical periodontal therapy (NSPT). This systematic review and meta-analysis aimed to evaluate the clinical efficacy of Omega-3 PUFA supplementation, with or without acetylsalicylic acid (ASA), in patients with periodontitis.MethodsElectronic and manual searches were conducted across MEDLINE (PubMed), the Cochrane Central Register of Controlled Trials, and Google Scholar up to September 2025. Randomized controlled trials (RCTs) assessing NSPT combined with Omega-3 supplementation for ≥1 month were included. Primary outcomes were changes in clinical attachment level (CAL) and probing pocket depth (PPD); data were pooled using random-effects models, and risk of bias was assessed with the Cochrane RoB 2 tool.ResultsSixteen RCTs met the inclusion criteria, and nine were included in the quantitative synthesis. Meta-analysis revealed significant improvements in CAL [mean difference (MD) = −0.49 mm; 95% CI −0.75 to −0.23] and PPD (MD = −0.44 mm; 95% CI −0.62 to −0.25) at 3 months, favoring NSPT + Omega-3 over NSPT alone. At 6 months, differences remained favorable and statistically significant for both CAL (MD = −0.58 mm; 95% CI −0.96 to −0.21) and PPD (MD = −0.45 mm; 95% CI −0.76 to −0.14).ConclusionsAdjunctive Omega-3 PUFA supplementation improves short-term periodontal healing following NSPT, yielding modest but clinically meaningful benefits in CAL and PPD. Despite promising results, further standardized RCTs are needed to confirm long-term efficacy and clarify the potential synergistic role of ASA co-administration.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42024508208, PROSPERO CRD42024508208.

Background: Clinical attachment level (CAL), alveolar bone loss, and periodontal pockets constitute the major signs of periodontitis. The interaction between the host and the bacteria that forms a biofilm on the tooth surface is one of the major etiologies of periodontal disorders. Aim: The aim of this study was to assess interleukin-35 (IL-35) levels pre and post nonsurgical periodontal therapy (NSPT) in healthy individuals and gingivitis and periodontitis patients. Materials and Methods: IL-35 level in gingival crevicular fluid (GCF) and clinical parameters were assessed in 60 individuals. Biochemical analysis was done by enzyme-linked immunosorbent assay. Individuals in Group I were in good health; those in Groups II and III had gingivitis and periodontitis, respectively. Study individuals were evaluated at baseline and 3 months after NSPT. Results: Group III differed from Group II in that it had higher CAL (7.60), plaque index (2.8929), and periodontal probing depth (5.8500 mm) values, as well as lower papillary bleeding index (2.1170) and gingival index (2.1085) values. The concentrations of IL-35 in GCF varied among the groups, with Group III having the lowest concentrations and rising gradually to Groups II and I. In addition, from baseline to 3 months, the IL-35 levels in GCF significantly decreased in both Groups II and III. The results show that Groups II and III have lower GCF levels of IL-35 than Group I, suggesting that IL-35 is a major factor in the development of periodontal diseases. Conclusion: Group I had considerably greater GCF IL-35 values than Group II and III both before and after NSPT.

Effect of non-surgical periodontal therapy on the fibrinogen levels in chronic periodontitis patients

INTRODUCTIONSmokeless tobacco (SLT) jeopardizes periodontal health and also produces an imbalance between reactive oxygen species (ROS) and antioxidants (AO) such as glutathione. Glutathione is an important redox regulator in saliva and its maintenance is essential for periodontal health. Periodontitis patients have a reduced total AO capacity in whole saliva, and periodontal therapy restores the redox balance. Hence, the purpose of this study was to investigate the effects of smokeless tobacco use on saliva glutathione levels in patients with chronic periodontitis and to evaluate these effects after non-surgical periodontal therapy.METHODSThe study included 100 subjects in four groups; healthy, gingivitis, and chronic periodontitis (CP) patients with and without SLT use. Saliva samples were collected, and clinical periodontal parameters were recorded at baseline and at one month after non-surgical periodontal therapy. Glutathione levels were analyzed using spectrophotometry at 412 nm. Statistical analysis was carried out using paired t-test, chi-squared, and analysis of variance (ANOVA).RESULTSMean glutathione values in saliva were found to be lower in periodontitis patients compared to SLT users at baseline and at 1 month post non-surgical periodontal therapy (p<0.001) In addition, non-surgical therapy leads to a highly significant improvement in the glutathione levels in gingivitis, in the CP with and without ST groups (p<0.001).CONCLUSIONSSuccessful non-surgical periodontal therapy leads to considerable progress in the redox balance, thus regulating glutathione levels and reducing the effects of SLT on the periodontium. This emphasises the importance of non-surgical therapy, especially among SLT users.

Monitoring is the global method of observation and data recording in relation to body organ and system function that afford constant information to ensure continuous evalutation of the patient's physical condition. Basic monitoring provides essential information for assessing the vital signs, both circulatory and respiratory, and fundamentally comprises the control of blood pressure (BP) and heart rate (HR) and rhythm. Pulse oxymetry is used to record HR and oxygen saturation. The objective of the study was to assess and compare hemodynamic changes by monitoring oxygen saturation level changes during periodontal surgical and nonsurgical therapy. A cross-sectional observational study was conducted in 30 chronic periodontitis patients. Patients were divided into two groups; Group A consisted of 15 patients undergoing surgical periodontal therapy, Group B consisted of 15 patients undergoing nonsurgical periodontal therapy. The hemodynamic changes were evaluated by monitoring HR and oxygen saturation level using pulse oxymeter (SaO₂). HR and SaO₂ were monitored continuously and registered pre-operatively, i.e. 10 minutes before the procedure, intra-operatively and postoperatively, i.e. 10 minutes after the procedure. One-way analysis of variance test (ANOVA) was performed for data analysis. Both the groups showed a slight fall in oxygen saturation levels intraoperatively, but within the normal range. More decrease in oxygen saturation levels was observed in nonsurgical periodontal therapy as compared to surgical periodontal therapy at intraoperative levels. The differences in the values were statistically significant. There was no statistical difference seen in the postoperative and preoperative values. Most of the hemodynamic changes induced during the periodontal therapy were within normal limits, taking into consideration the anxiety and stress produced by the surgical intervention. The hemodynamic change was more in nonsurgical as compared to surgical periodontal therapy.

ObjectivesThe primary aim of the present study was to compare the reduction in periodontal probing depth after the use of either local or systemic adjuvant antibiotics during non-surgical periodontal therapy at baseline and the six-month follow-up. Secondary aims were to compare other clinical outcomes, total bacterial count, and relative expression levels of certain pro-inflammatory mediators following the use of locally and systemically delivered adjuvant antibiotics during the initial non-surgical periodontal therapy (NSPT).Material and methodsA total of 38 periodontitis stage III grade B or C patients were randomly and equally assigned to receive either local (LA) (tazobactam + piperacillin preparation) or systemic antibiotics (SA) (amoxicillin and metronidazole combination) during NSPT. Clinical periodontal parameters (periodontal probing depth, clinical attachment level, bleeding on probing, and plaque index), and microbiological and immunological parameters: total bacterial count, and relative expression levels of IL-17 and TNF-α were evaluated at baseline and six months after NSPT.ResultsBoth LA and SA significantly improved all clinical parameters after six months (p<0.001 for all comparisons). While a significant decrease of total bacterial count was observed after LA (p=0.001) and SA treatment (p=0.013), the insignificant differences between the two groups were observed after the sixth-month follow-up (p>0.05). Conversely, relative gene expression levels of IL-17 and TNF-α did not differ significantly between LA and SA six months after the NSPT. The insignificant differences between these cytokines’ relative levels were observed in both SA and LA between baseline and follow-up measurements.ConclusionsThe adjuvant use of piperacillin + tazobactam led to the comparable improvement of clinical, microbiological and immunological parameters to the conventional use of amoxicillin and metronidazol combination six months following the initial therapy of periodontitis. Therefore, these locally delivered antibiotics might be a promising alternative to the standard use of systemic amoxicillin and metronidazol combination during initial therapy of stage III periodontitis.