A comparative clinical evaluation of Aminobisphosphonates (Alendronate) in the management of periodontal osseous defects– A controlled clinical trial

Introduction: Deep intraosseous defects represent a major challenge for the clinician. Sites with intraosseous lesions have been shown to be at higher risk of disease progression in subjects who had not received periodontal therapy. Treatments of intrabony defects include scaling and root planing with surgical access flap. Additional osseous resective therapy and ⁄ or reconstructive therapy by means of the application of membranes, biological agents or grafting biomaterials can be used to correct the bone deformities induced by destructive periodontal disease and achieve regeneration. Host modulation is a promising new adjunctive therapeutic option for the management of periodontal diseases. The purpose of host modulation therapy is to restore the balance of proinflammatory or destructive mediators and anti-inflammatory or protective mediators to that seen in healthy individuals. Bisphosphonates are bone seeking agents that inhibit bone resorption by disrupting osteoclast activity. They interfere with osteoblast metabolism and secretion of lysosomal enzymes. More recent evidence has suggested that bisphosphonates also possess anticollagenase properties. In human studies, these agents resulted in enhanced alveolar bone status and density. (El-Shinnawi et al-2003) Alendronate was approved by the FDA in the USA in 1995 and studies have reported the effectiveness of ALN in preventing alveolar bone destruction associated with periodontal disease when administered systemically or locally to the target site. It is with this background and since limited studies have been conducted using alendronate as a graft material, this study was undertaken. Aim: To evaluate & compare the efficacy of Open flap debridement, Open flap debridement with Autogenous bone and Open flap debridement with Autogenous bone and Alendronate for the treatment of 2 walled and 3 walled intraosseous defects. Materials & Methods: 30 Subjects in the age range of 30 – 60 years were selected with chronic (clinical attachment loss > 5mm) periodontitis and probing depth ≥ 6mm were selected. Mandibular molars, with 2 or 3 walled intrabony defects were included in the study, with no history of metabolic disorders involving bone resorption. Radiographic evidence of bone defects were evident. Results: Mean measurements in the Group C for CAL gain (2.90 ±0.73), PD reduction (3.10 ±0.73) and RBH (2.40 ±0.96) were significantly greater with a p-value <0.05 compared to the mean measurements of CAL gain (3.80 ±0.78), PD reduction (4.40 ±1.17) and RBH (3.50 ±0.84) of Group A. Conclusion: Use of Alendronate- bisphosphonate as an additive material to autogenous bone grafts demonstrated improved results at 6 months and 9 months as compared to baseline.