Abstract
Objectives: To qualitatively and quantitatively review the use of melatonin as a topical/systemic formulation for the management of periodontitis. Materials and methods: PubMed; Scopus; and Web of Science databases were searched using the MesH terms “melatonin” and “periodontitis”. Title and abstracts were screened to eliminate irrelevant and duplicate articles. The full text data of the screened articles were assessed using the selection criteria. Results: Of 176 identified articles (PubMed-66; Scopus-56; Web of Science-52; Cross-reference-2), only 12 studies qualified to be included in the systematic review. Four studies assessed the independent effect of 1% topical melatonin formulation while 8 articles assessed the adjunctive use of systemic melatonin formulation (1–10 mg) following scaling and root planing (SRP). All studies showed an improvement in periodontal parameters such as pocket depth, clinical attachment loss, periodontal disease index, community periodontal index, gingival bleeding scores, and prognostic marker levels in saliva and serum. A meta-analysis of data from 2 studies revealed that 1–2 mg (systemic) melatonin supplementation reduced pocket depth; although the difference was not statistically significant and hence cannot be interpreted or used for conclusive evidence. Risk of Bias Assessment tool (RoBANS) and Cochrane Collaboration RoB tool elicited a high risk of bias in the included studies. GRADE (recommendation assessment, development, and evaluation) inferred a weak recommendation for the use of melatonin in periodontitis management. Conclusions: Melatonin supplementation (topical and systemic) in periodontitis patients improved key periodontal parameters including pocket depth and clinical attachment loss. Clinical relevance: Melatonin could be a potential host modulatory agent for periodontitis management; although the data from the present review should be interpreted carefully due to the associated high risk of bias.
Highlights
Complete dental plaque and calculus removal form the basis of periodontal therapy as pathogens from plaque are initiators of periodontal disease [1]
Melatonin has been assayed in saliva [19], gingival crevicular fluid (GCF) [20], and gingival tissues [18], and its overall levels were found to be lowered in patients with periodontitis than healthy controls
This study found a significant reduction in gingival index (GI), pocket depth (PD), and clinical attachment loss (CAL) in patients receiving a synergistic combination of melatonin and vitamin C compared to melatonin alone
Summary
Complete dental plaque and calculus removal form the basis of periodontal therapy as pathogens from plaque are initiators of periodontal disease [1]. A recently published systematic review performed by some of us, found a depletion of salivary melatonin levels in patients with periodontitis versus healthy individuals [21]. This finding is significant as it highlights the need for melatonin supplementation in the management of periodontal disease. The present systematic review and meta-analysis were performed with the aim of qualitatively and quantitatively analyzing the published literature that has assessed melatonin in TF/SF for the management of periodontitis
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